| 1. |
- Starck, Joachim, et al.
(författare)
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Abdominal aortic aneurysm growth rates are not correlated to body surface area in screened men
- 2023
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Ingår i: International Angiology. - : EDIZIONI MINERVA MEDICA. - 1827-1839 .- 0392-9590. ; 42:1, s. 65-72
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Screening for abdominal aortic aneurysm (AAA) in 65-year-old males reduces aneurysm related mortality. Infrarenal aortic diameter (IAD) has been shown to correlate to body surface area (BSA) which could influence diagnostic criteria for AAA. This study investigates whether AAA growth rates are also dependent on BSA, as that might have potential effects on surveillance of small AAAs.METHODS: We conducted a retrospective, single center cohort study of 301 men with screening detected AAA between 2010-2017 with surveillance to 2021. AAA growth rates were analyzed in relation to the subject's BSA, smoking habits, and diabetic disease using a linear mixed-effects model. All men were offered smoking cessation program, optimized medical treatment, and advice on physical activity.RESULTS: The screening program included 28,784 men. Of the 22,819 (79%) attending the examinations, 374 men (1.6%) were found to have an AAA out of which 301 men had undergone two or more examinations during surveillance and were included with a median follow-up of 1846 days (IQR: 1 399). Mean unadjusted AAA growth rate was 1.60 mm/year (95% CI: 1.41-1.80). Diabetes mellitus had a statistically significant negative impact, smoking had a statistically significant positive impact on AAA growth rates whereas no correlation between AAA growth rate and BSA could be found.CONCLUSIONS: Body surface area could not be found to have a statistically significant correlation to AAA growth rates. The impact of smoking and diabetes on AAA growth rates remains similar to previously reported.
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| 2. |
- Asciutto, Giuseppe, et al.
(författare)
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Early experience with the Bolton Relay Pro/Plus for physician-modified fenestrated TEVAR
- 2022
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Ingår i: International Journal of Angiology. - : Edizioni Minerva Medica. - 0392-9590 .- 1827-1839. ; 41:2, s. 105-109
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Tidskriftsartikel (refereegranskat)abstract
- Background: Thoracic endovascular aortic repair (TEVAR) can be challenging in cases involving the aortic arch and the visceral segment. We report our initial experience with fenestrated TEVAR (f-TEVAR) for thoracic aortic disease involving aortic branches using physician-modified stent grafts (PMSGs). Methods: Between February 2019 and November 2020 nine patients were treated with a PMSG. Indication to treatment were a symptomatic acute type B aortic dissection (TBAD) in three cases, a penetrating aortic ulcer in three cases (two in zone 3 and one in zone 6), one case of an endoleak type IA after TEVAR, a chronic TBAD after TEVAR in one case and one case of a contained rupture of a thoracoabdominal aneurysm in zone 3. Pre-, intra-and postoperative clinical data were recorded. Results: The median patient age was 65 (IQR 60.5-71) years, and eight (89%) patients were men. Nine stent grafts (six Bolton Relay Plus and three Bolton Relay Pro, Terumo Aortic, Vascutek Ltd., Inchinnan, UK) were deployed. Small fenestrations (8 mm) were created on table, median duration for on table stent graft modifications was 20 minutes (range 13-22). The technical success rate was 100%. Median operative time was 188 (range 116-252) minutes. No major adverse events of any sort occurred during the first 30-day postoperatively. There were no type I or type III endoleaks at the end of the procedure, and no cases of spinal cord ischemia. Two access related complications occurred (22%). After a median of 12 (range 5-12) months all patients survived and all target vessels remained patent with one case of fenestration-related type I endoleak, which required open conversion. Conclusions: The results of our initial experience with f-TEVAR using PMSGs with the Bolton Relay stentgraft for the treatment of aortic diseases are acceptable. These results should be confirmed on larger patient cohorts. (Cite this article as: Asciutto G, Usai MV, Ibrahim A, Oberhuber A. Early experience with the Bolton Relay Pro/Plus for physician-modified fenestrated TEVAR. Int Angiol 2022;41:105-9. DOI: 10.23736/S03929590.22.04745-9)
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| 3. |
- Hager, Jakob, et al.
(författare)
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Revisiting the cost-effectiveness of screening 65-year-old men for abdominal aortic aneurysm based on data from an implemented screening programme.
- 2017
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Ingår i: International Journal of Angiology. - : Edizioni Minerva Medica. - 0392-9590 .- 1827-1839. ; 36:6, s. 517-525
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Health economic analyses based on randomized trials have shown that screening for abdominal aortic aneurysm (AAA) cost-effectively decreases AAA-related, as well as all- cause mortality. However, follow-up from implemented screening programmes now reveal substantially changed conditions in terms of prevalence, attendance rate, costs and mortality after intervention. Our aim was to evaluate whether screening for AAA among 65-year-old men is cost-effective based on contemporary data on prevalence and attendance rates from an ongoing AAA screening programme.METHODS: A decision-analytic model, previously used to analyse the cost-effectiveness of an AAA screening programme prior to implementation in clinical practice, was updated using data collected from an implemented screening programme as well as data from contemporary published data and the Swedish register for vascular surgery (Swedvasc).RESULTS: The base-case analysis showed that the cost per life-year gained and quality-adjusted life year (QALY) gained were €4832 and €6325, respectively. Based on conventional threshold values of cost-effectiveness, the probability of screening being cost-effective was high.CONCLUSION: Despite the reduction of AAA-prevalence and changes in AAA-management over time, screening 65-year-old men for AAA still appears to yield health outcomes at a cost below conventional thresholds of cost-effectiveness.
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| 4. |
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| 5. |
- Acosta, Stefan, et al.
(författare)
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The clinical importance in differentiating portal from mesenteric venous thrombosis
- 2011
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Ingår i: International Journal of Angiology. - 0392-9590 .- 1827-1839. ; 30:1, s. 71-78
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Tidskriftsartikel (refereegranskat)abstract
- Aim. To relate the extent of portomesenteric thrombosis to the risk of intestinal infarction, concomitant venous thromboembolism and underlying diseases. Methods. Identification of patients with mesenteric (MVT) and portal vein thrombosis (PVT) at Malmo University Hospital from a clinical series from 2000 - 2006 as well as an autopsy cohort of 24000 consecutive autopsies from 1970 - 1982. Results. In the clinical comparative study, MVT (n=51) was associated with more thrombophilic disorders (P=0.040) and intestinal infarctions (P=0.046), whereas patients with PVT without extension to the superior mesenteric vein (n=20) more often had liver disease (P < 0.001). At autopsy, 270 patients with portomesenteric venous thrombosis were found; twenty-nine out of the 31 cases with MVT had intestinal infarction. None (0%) of the 239 patients with PVT without extension into the superior mesenteric vein had intestinal infarction. Portomesenteric venous thrombosis and intestinal infarction was associated with concomitant venous thromboembolism (O. R. 6.1 [95% CI 1.8-21]). Conclusions. MVT carries a high risk of developing intestinal infarction and is associated with concomitant venous thromboembolism, whereas PVT is associated with liver disease.
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| 6. |
- Barani, Jamal, et al.
(författare)
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Suboptimal treatment of risk factors for atherosclerosis in critical limb ischemia
- 2005
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Ingår i: International Angiology. - 0392-9590 .- 1827-1839. ; 24:1, s. 59-63
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Tidskriftsartikel (refereegranskat)abstract
- Aim. The epidemiology of critical limb ischemia (CLI) is insufficiently studied, and treatment of risk factors for atherosclerosis has received less attention in CLI patients than in patients with coronary or precerebral atherosclerosis. The aim of this study was to establish the incidence of CLI and the quality of risk factor treatment in Swedish CLI patients. Methods. During 14 months, 316 consecutive CLI patients were referred to the Malmö Department of Vascular Diseases. Two hundred and fifty-nine (82%) consented to evaluation of intercurrent disease, medication, ankle and arm blood pressures (BP), plasma glucose and lipid levels, phomocysteine, cardiolipin antibodies and activated protein C (APC)-resistance. Results. The incidence of CLI was 38/100 000 inhabitants/year. Patient age was 75±10 years, and BP 147±26/75±14 mmHg. Systolic or diastolic BP above recommended levels (140/90 mmHg) occurred in 137 (53%) patients. P-cholesterol was 4.8±1.2 mMol/L, but cholesterol above recommended level (5 mMol/L) or LDL above recommended level (3 mMol/L) occurred in 125 (48%) patients. Only 24% of patients met national recommendations for both BP and lipid levels. Diabetes mellitus was previously known in 123 (47%) patients, and another 12 (5%) patients showed diabetic fasting glucose levels during the hospital stay. Eightyfour (32%) patients were active, and 72 (28%) were former smokers. Myocardial infarction or angina pectoris had previously been diagnosed in 123 (47%) patients. P-homocysteine was 17±7 μol/l, cardiolipin antibodies occurred in 71 (27%) and APC-resistance in 34 (13%) patients. Conclusion. Patients with CLI show high comorbidity in vascular diseases and high prevalence of modifiable risk factors for atherosclerotic vascular disease. The use of evidence-based medical therapy is suboptimal in this high-risk group.
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| 7. |
- Bergqvist, David, et al.
(författare)
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Abdominal aortic aneurysm and new WHO criteria for screening
- 2013
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Ingår i: International Journal of Angiology. - 0392-9590 .- 1827-1839. ; 32:1, s. 37-41
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Forskningsöversikt (refereegranskat)abstract
- Does screening of abdominal aortic aneurysm (AAA) fulfil the recently revised the World Health Organization WHO criteria for screening? Contemporary data from the literature are used to analyze whether the ten recent WHO criteria can be used to motivate AAA screening. Although the prevalence of AAA seems to decrease, at least screening of 65-year old males saves lives and is cost-effective. Ultrasonographic screening for AAA in risk populations fulfils the new WHO criteria for screening.
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| 8. |
- Bergqvist, David
(författare)
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Vascular injuries caused by acupuncture : A systematic review
- 2013
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Ingår i: International Journal of Angiology. - 0392-9590 .- 1827-1839. ; 32:1, s. 1-8
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Forskningsöversikt (refereegranskat)abstract
- AIM: The aim of the study was to systematically review the literature on vascular injuries caused by acupuncture.METHODS: This was a systematic literature search in Medline and PubMed.RESULTS: Thirty-one cases were identified and the majority developed symptoms in direct connection with the acupuncture treatment. Three patients died, two from pericardial tamponade and one from an aortoduodenal fistula. There were seven more tamponades, eight pseudoaneurysms, two with ischemia, two with venous thrombosis, one with compartment syndrome and seven with bleeding (five in the central nervous system). The two patients with ischemia had remaining sequeleae. Information on follow-up was suboptimal with no information in fourteen patients.CONCLUSION: Vascular injuries are rare, bleeding and pseudoaneurysm dominating. Follow-up is insufficient in the hitherto published papers.
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| 9. |
- Danielsson, P., et al.
(författare)
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Systemic white blood and endothelial cell response after revascularization of critical limb ischemia is only influenced in case of ischemic ulcers
- 2006
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Ingår i: International Journal of Angiology. - 0392-9590 .- 1827-1839. ; 25:3, s. 310-315
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Tidskriftsartikel (refereegranskat)abstract
- AIM: The aim of this study was to study the inflammatory response to open revascularization of an ischemic leg in terms of activation of white blood cells (WBC), platelets and endothelial cells. DESIGN: prospective study. METHODS: Venous samples from 21 patients suffering critical limb ischemia (CLI) were drawn before, and 4 weeks after (20 patients) revascularization. Total WBC, differentiated WBC, and platelets were counted. Expression of CD11b/CD18 on granulocytes and monocytes and CD41 on platelets was measured by flow cytometry. Soluble endothelial markers (sICAM-1, sVCAM-1, sE-selectin and sP-selectin) were analysed with ELISA. RESULTS: WBC and granulocyte count decreased in the subgroup of patients with ulcer and gangrene but no change in activation of WBC was recorded. The endothelial marker sICAM-1 decreased while VCAM-1 increased following surgery, most evident in the subgroup with ulcers and gangrene. CONCLUSIONS: This study shows that revascularization of CLI does not significantly influence the inflammatory response in patients with rest pain only, but a limited response of down regulation was found in the ulcer/gangrene patients probably as an effect of healing ulcers.
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| 10. |
- El Marghani, Ahmed M., et al.
(författare)
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High MAPK p38 activity and low level of IL-10 in intermittent claudication as opposed to stable angina
- 2010
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Ingår i: International Journal of Angiology. - Torino : Minerva Medica. - 0392-9590 .- 1827-1839. ; 29:4, s. 331-337
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Tidskriftsartikel (refereegranskat)abstract
- AIM:The aim of the present pilot study was to relate the activity of MAPK p38 with the levels of pro- and anti-inflammatory cytokines in a small cohort of patients with either stable angina (N=5) or intermittent claudication (N=5) compared to healthy controls (N=10).METHODS:The activity of MAPK p38 was determined in peripheral blood mononuclear cells, isolated from whole blood by western blot using phospho-specific anti-MAPK p38 antibodies. Cytokine levels of 11 pro- and anti-inflammatory cytokines were determined from the serum using flow cytometry.RESULTS:We found a significant elevation of the MAPK p38 activity in the intermittent claudication group (P=0.0027) compared with the healthy control group whereas the stable angina group showed similar MAPK p38 activity as the healthy control group. The IL-10 level in serum found in the stable angina group was significantly higher compared with both the healthy control group (P=0.0116) and the intermittent claudication group (P=0.0317).CONCLUSION:Our results imply that there is a casual relationship between increased levels of the anti-inflammatory cytokines IL-10 and IL-4 and the activity of the MAPK p38. Possibly has IL-10 a protective role that down-regulates the activity of MAPK p38 and thereby further inflammatory processes in stable angina patients.
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| 11. |
- Hager, Jakob, 1967-, et al.
(författare)
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Population-based survival rate with a one- or two-stop referral pattern for patients with ruptured abdominal aortic aneurysms
- 2013
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Ingår i: International Journal of Angiology. - Turin, Italy : Edizioni Minerva Medica. - 0392-9590 .- 1827-1839. ; 32:5, s. 492-500
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Tidskriftsartikel (refereegranskat)abstract
- AIM:Is there a difference in the population-based survival rate for patients with ruptured abdominal aortic aneurysms (rAAA), handled by a "one-stop" or a "two-stop" referral pattern?METHODS:Ten regions in Sweden were identified where clear-cut "one-stop" or "two-stop" referral-patterns prevailed. From the Swedvasc Registry we identified 849 patients operated on for rAAA, 1987 to 2004, living in any of these ten regions, and related the number of survivors to the whole population served by each hospital.RESULTS:The population-based survival rate was 14% lower for patients following a "two-stop" compared to a "one-stop" referral pattern (P=0.084). For the group 65-74 years-of-age the difference was significant (P=0.021), but no corresponding effect was seen regarding operative mortality rate or sex.CONCLUSION:Compared to a "one-stop" referral pattern for rAAA, a "two-stop" referral pattern results in a lower population-based survival rate for patients 65-74 years old, but the consequences would be small even if a "one-stop" referral pattern could be generally accomplished.
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| 12. |
- Jonsson, Thomas B., 1971-, et al.
(författare)
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Adverse events during treatment limb ischemia with autologous peripheral blood mononuclear cell implant
- 2012
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Ingår i: International Journal of Angiology. - Turin, Italy : Edizioni Minerva Medica. - 0392-9590 .- 1827-1839. ; 31:1, s. 77-84
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Tidskriftsartikel (refereegranskat)abstract
- Aim: Trials have reported clinical improvement and reduced need for amputation in critical limb ischemia (CLI) patients receiving therapeutic angiogenesis with stem cells. Our objective was to test peripheral stem cell therapy efficacy and safety to gain experiences for further work.Methods: We included nine CLI patients (mean age 76.7 ±9.7). Stem cells were mobilized to the peripheral blood by administration of G-CSF (Filgrastim) for 4 days, and were collected on day five, when 30 mL of a stem cell suspension was injected into 40 points of the limb. The clinical efficacy was evaluated by assessing pain relief, wound healing and changes in ankle-brachial pressure index (ABI). Local metabolic and inflammatory changes were measured with microdialysis, growth factors and cytokine level determination. Patients were followed for 24 weeks.Results: Four patients experienced some degree of improvement with pain relief and/or improved wound healing and ABI increase. One patient was lost to follow up due to chronic psychiatric illness; one was amputated after two weeks. Two patients had a myocardial infarction (MI), one died. One patient died from a massive mesenteric thrombosis after two weeks and one died from heart failure at week 11. Improved patients showed variable effects in cytokine-, growth factor- and local metabolic response.Conclusion: Even with some improvement in four patients, severe complications in four out of nine patients, and two in relation to the bone marrow stimulation, made us terminate the study prematurely. We conclude that with the increased risk and the reduced potential of the treatment, peripheral blood stem cell treatment in the older age group is less appropriate. Metabolic and inflammatory response may be of value to gain insight into mechanisms and possibly to evaluate effects of therapeutic angiogenesis.
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| 13. |
- Karacagil, Sadettin, et al.
(författare)
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Patterns of atherosclerotic occlusive disease of lower leg and pedal arteries in hypertensive patients undergoing infrainguinal bypass procedures
- 1995
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Ingår i: International Journal of Angiology. - 0392-9590 .- 1827-1839. ; 15:1, s. 57-60
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: To analyse the atherosclerotic involvement of lower leg and foot arteries in patients undergoing infrainguinal bypass grafting. SETTING: Department of Surgery, University Hospital. PATIENTS: Among 282 limbs (267 patients), fifty limbs belonged to hypertensive nondiabetics (Group A), 39 to hypertensive diabetics (Group B), 129 to normotensive nondiabetics (Group C) and 64 to normotensive diabetics (Group D). INTERVENTIONS: Femoropopliteal or femorodistal bypass procedures. MEASURES: Intraoperative postreconstruction serial angiography of the lower leg and foot arteries. RESULTS: Occlusion rate of two or three lower leg arteries was significantly higher among diabetics (Group B 77% and Group D 73%, respectively) compared to nondiabetics (Group A 56% and Group D 51%, respectively). It was similar in diabetic patients with or without hypertension. The incidence of having both foot arches (dorsal and plantar arch) intact was significantly higher in nondiabetic patients with hypertension (Group A). Only 5.8% of these patients demonstrated both deficient or occluded foot arches compared to 18% in Group B and 31% in Group C and 20% in Group D. CONCLUSION: Hypertension does not seem to contribute to the extent and severity of lower leg and foot vessel involvement in patients undergoing infrainguinal bypass surgery.
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| 14. |
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| 15. |
- Lee, Byung-Boong, et al.
(författare)
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Venous hemodynamic changes in lower limb venous disease : the UIP consensus according to scientific evidence
- 2016
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Ingår i: International Journal of Angiology. - : Springer. - 0392-9590 .- 1827-1839. ; 35:3, s. 236-352
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Tidskriftsartikel (refereegranskat)abstract
- There are excellent guidelines for clinicians to manage venous diseases but few reviews to assess their hemodynamic background. Hemodynamic concepts that evolved in the past have largely remained unchallenged in recent decades, perhaps due to their often complicated nature and in part due to emergence of new diagnostic techniques. Duplex ultrasound scanning and other imaging techniques which evolved in the latter part of the 20th century have dominated investigation. They have greatly improved our understanding of the anatomical patterns of venous reflux and obstruction. However, they do not provide the physiological basis for understanding the hemodynamics of flow, pressure, compliance and resistance. Hemodynamic investigations appear to provide a better correlation with post-treatment clinical outcome and quality of life than ultrasound findings. There is a far better prospect for understanding the complete picture of the patient's disability and response to management by combining ultrasound with hemodynamic studies. Accordingly, at the instigation of Dr Angelo Scuderi, the Union Internationale de Phlebologie (UIP) executive board commissioned a large number of experts to assess all aspects of management for venous disease by evidence-based principles. These included experts from various member societies including the European Venous Forum (EVF), American Venous Forum (AVF), American College of Phlebology (ACP) and Cardiovascular Disease Educational and Research Trust (CDERT). Their aim was to confirm or dispel long-held hemodynamic principles and to provide a comprehensive review of venous hemodynamic concepts underlying the pathophysiology of lower limb venous disorders, their usefulness for investigating patients and the relevant hemodynamic changes associated with various forms of treatment. Chapter 1 is devoted to basic hemodynamic concepts and normal venous physiology. Chapter 2 presents the mechanism and magnitude of hemodynamic changes in acute deep vein thrombosis indicating their pathophysiological and clinical significance. Chapter 3 describes the hemodynamic changes that occur in different classes of chronic venous disease and their relation to the anatomic extent of disease in the macrocirculation and microcirculation. The next four chapters (Chapters 4-7) describe the hemodynamic changes resulting from treatment by compression using different materials, intermittent compression devices, pharmacological agents and finally surgical or endovenous ablation. Chapter 8 discusses the unique hemodynamic features associated with alternative treatment techniques used by the CHIVA and ASVAL. Chapter 9 describes the hemodynamic effects following treatment to relieve pelvic reflux and obstruction. Finally, Chapter 10 demonstrates that contrary to general belief there is a moderate to good correlation between certain hemodynamic measurements and clinical severity of chronic venous disease. The authors believe that this document will be a timely asset to both clinicians and researchers alike. It is directed towards surgeons and physicians who are anxious to incorporate the conclusions of research into their daily practice. It is also directed to postgraduate trainees, vascular technologists and bioengineers, particularly to help them understand the hemodynamic background to pathophysiology, investigations and treatment of patients with venous disorders. Hopefully it will be a platform for those who would like to embark on new research in the field of venous disease.
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| 16. |
- Liapis, C. D., et al.
(författare)
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European continuing medical education in vascular surgery : 5-year results of congresses approved by the Union Européenne des Médecins Spécialistes Section of Vascular Surgery
- 2007
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Ingår i: International Journal of Angiology. - 0392-9590 .- 1827-1839. ; 26:4, s. 361-366
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Tidskriftsartikel (refereegranskat)abstract
- AIM: Continuing medical education (CME) can be defined as ''educational activities that serve to maintain, develop, or increase the knowledge, skills and professional performance of a physician to provide services for patients, the public, or the profession''. CME is a major professional responsibility. The European Board of Vascular Surgery of the Union Européenne des Médecins Spécialistes (UEMS) Section of Vascular Surgery has, through its European Vascular CME (EVCME) Committee, accredited 74 congresses during the 5-year period from 2000-2004. METHODS: Official evaluation forms were completed by the congress participants for a personal appraisal of the quality of the activities. The data in this manuscript focused on questions that were the most relevant and of the greatest interest to the participants. A statistical analysis of the results was performed utilizing ANOVA and Robust tests of equality of means as well as a posthoc analysis for further investigation, and non parametric Wilcoxon signed ranks test. RESULTS: The educational needs of participants regarding new diagnostic and therapeutic modes were stated as ''important'' and ''extremely important'' in the responses at over 80% in total. Over 75% of the participants answered ''extremely important'' and ''important'' to the question ''how important is evidence-based practice to your practice''. CONCLUSION: This survey indicates that the EVCME approved congresses had a positive impact for the vascular surgeon by updating overall knowledge on vascular surgery; the majority of comments by the participants also indicates that EVCME is fulfilling its aim to bring as much evidence-based practice as possible into the daily work schedule of the surgeon by turning knowledge acquired by CME into performance of the participants.
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| 17. |
- Lundgren, Fredrik
(författare)
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Does patency after a vein collar and PTFE-bypass depend on sex and age? Re-analysis of a randomised trial
- 2012
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Ingår i: International Journal of Angiology. - : Edizione Minerva Medica. - 0392-9590 .- 1827-1839. ; 31:2, s. 156-162
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Tidskriftsartikel (refereegranskat)abstract
- Aim. Randomized studies evaluating the effect of a vein collar at the distal anastomosis of PTFE-grafts show conflicting results. The study of the Joint Vascular Research Group (JVRG) of UK found improved primary patency while the Scandinavian Miller Collar Study (SCAMICOS) found neither any effect on patency nor on limb salvage after bypass to below-knee arteries. However, the Scandinavian patients were a decade older and predominately female compared to the British patients. Can this explain the conflicting result? less thanbrgreater than less thanbrgreater thanMethods: Primary patency with respect to sex, age and the use of vein collar were re-analysed in 345 patients from SCAMICOS with Kaplan-Meier life-table technique, log-rank test and Cox proportional hazards regression to evaluate any interaction between sex or age and the effect of a vein collar on the primary patency rate. less thanbrgreater than less thanbrgreater thanResults. Females had better patency than males (log-rank test, chi(2)=9.4, df=1, P=0.002) but age had no influence on patency (log-rank test, chi(2)=3.3, df=3, P=0.35). However, 47% of the males compared to 23% of the females were smokers (P=0.00002). No interaction effect between sex and vein collar (P-value=0.224) or age and vein collar (P-value=0527) was established. less thanbrgreater than less thanbrgreater thanConclusion. The difference between the two randomised vein collar studies are unlikely to depend on the disparity in sex and age of the study populations.
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| 18. |
- Lundgren, F
(författare)
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Does patency after a vein collar and PTFE-bypass depend on sex and age? Re-analysis of a randomised trial.
- 2012
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Ingår i: International Journal of Angiology. - 0392-9590 .- 1827-1839. ; 31:2, s. 156-62
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Tidskriftsartikel (refereegranskat)abstract
- AIM: Randomized studies evaluating the effect of a vein collar at the distal anastomosis of PTFE-grafts show conflicting results. The study of the Joint Vascular Research Group (JVRG) of UK found improved primary patency while the Scandinavian Miller Collar Study (SCAMICOS) found neither any effect on patency nor on limb salvage after bypass to below-knee arteries. However, the Scandinavian patients were a decade older and predominately female compared to the British patients. Can this explain the conflicting result?METHODS: Primary patency with respect to sex, age and the use of vein collar were re-analysed in 345 patients from SCAMICOS with Kaplan-Meier life-table technique, log-rank test and Cox proportional hazards regression to evaluate any interaction between sex or age and the effect of a vein collar on the primary patency rate.RESULTS: Females had better patency than males (log-rank test, χ2=9.4, df=1, P=0.002) but age had no influence on patency (log-rank test, χ2=3.3, df=3, P=0.35). However, 47% of the males compared to 23% of the females were smokers (P=0.00002). No interaction effect between sex and vein collar (P-value=0.224) or age and vein collar (P-value=0.527) was established.CONCLUSION: The difference between the two randomised vein collar studies are unlikely to depend on the disparity in sex and age of the study populations.
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| 19. |
- Lundgren, Fredrik
(författare)
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The effect on patency of type, shape and volume of a vein collar used at the distal anastomis of PTFE-bypass to arteries below-knee
- 2012
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Ingår i: International Journal of Angiology. - : Edizioni Minerva Medica. - 0392-9590 .- 1827-1839. ; 31:4, s. 348-355
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Tidskriftsartikel (refereegranskat)abstract
- AIM:The aim of this paper was to study the effect on patency rate of different types of vein collar (Miller's original or St Mary's boot), different length/height shapes of vein collar, and different vein collar volumes at the distal anastomosis of PTFE-bypass grafts to below-knee arteries in patients with critical limb ischemia.METHODS:One hundred eighty patients operated on with PTFE-bypass to below-knee arteries with a vein collar at the distal anastomosis were analyzed. They were recruited from a prospective randomized trial evaluating the effect of adding a vein collar to the distal anastomosis. Primary patency rate of the reconstructions were assessed against three factors: the type, shape, and volume of the vein collar. Univariate analysis was performed with the help of plotted Kaplan-Meier lifetable curves and log-rank tests and multivariate analysis with Cox proportional hazards regression.RESULTS:Type of vein collar had no influence on primary patency (logrank-test, χ(2)=0.8, df=1, P=0.377, N.=180). A length/height ratio of the vein collar between 1.18 and 1.63 were advantageous for primary patency but the effect was not statistically significant (logrank-test, chisq=5.5, df=2, P=0.063, N.=177). A large volume of the vein collar enhanced primary patency (logrank-test, chisq=6, df=2, P=0.050, N.=173). In the multivariate analysis, however, a larger volume and a length/height ratio between 1.18 and 1.63 as well as > 1.63 reduce the risk of graft failure with 48% (P=0.00006), 58% (P=0.007), 58% (P=0.004), respectively, while vein collar type had no effect on primary patency.CONCLUSION:This prospective observational study indicates that if a vein collar is used at the distal anastomosis of a PTFE-bypass to below-knee arteries it should be long compared to height and large in volume to improve primary patency rate, while the type of vein collar does not appear to matter.
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| 20. |
- Lundgren, Fredrik
(författare)
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The vein collar: an anastomotic servant or a patency promoter? Re-analysis of a randomized trial
- 2012
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Ingår i: International Journal of Angiology. - : Edizione Minerva Medica. - 0392-9590 .- 1827-1839. ; 31:3, s. 234-238
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Tidskriftsartikel (refereegranskat)abstract
- Aim. Randomized studies evaluating the effect of a vein collar at the distal anastomosis of PTFE-grafts show conflicting results. The study of the Joint Vascular Research Group (JVRG) of UK found improved primary patency while the Scandinavian Miller Collar Study (SCAMICOS) found neither any effect on patency nor on limb salvage after bypass to below-knee arteries. It has been discussed whether the questioned positive effect of a vein collar is due to technical advantages when the anastomosis is made rather than on a positive influence on the long-term effect by less pseudointima formation. less thanbrgreater than less thanbrgreater thanMethods. Primary patency regarding the use of vein collar were re-analyzed in 345 patients from SCAMICOS with Kaplan-Meier life-table technique and Cox proportional hazards regression in a counting process notation to evaluate any interaction between time-period and the effect of a vein collar on the primary patency rate. less thanbrgreater than less thanbrgreater thanResults. No overall effect on primary patency of a vein collar at the distal anastomosis was found irrespective of the site anastomosis. However, during the first 30 days of follow-up the primary patency among the femoro-crural bypasses was 0.87 (0.79-0.95) and 0.72 (0.63-0.83) with and without vein collar respectively. The interaction between vein collar and time-period was not statistically significant (P=0.070) and neither was the Score test for the whole interaction analysis (P=0.091) for the patients with anastomosis to the crural arteries. No such initial differences were found for the patients with anastomosis to the popliteal artery below-knee. less thanbrgreater than less thanbrgreater thanConclusion. A clinically relevant but not statistically significant better primary patency during the first 30 days was found for patients with PTFE-bypass to the crural arteries with a vein collar at the distal anastomosis. There were no long-term advantages of the vein collar irrespective of the location of the anastomosis.
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| 21. |
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| 22. |
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| 23. |
- Nordmyr, J., et al.
(författare)
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Vacuum assisted wound closure in patients with lower extremity arterial disease : The experience from two tertiary referral-centres
- 2009
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Ingår i: International Journal of Angiology. - 0392-9590 .- 1827-1839. ; 28:1, s. 26-31
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Tidskriftsartikel (refereegranskat)abstract
- AIM: The purpose of this investigation was to analyze predictors for wound healing, amputation and mortality after vacuum assisted closure (VAC) therapy of wounds in the lower limb in patients with arterial disease. METHODS: One hundred and twenty one wounds were treated and followed for 12 months at two vascular centres in Uppsala and Malmö, Sweden. VAC therapy was applied in the wound at a topical negative pressure of 125 mmHg. RESULTS: Median age of the patients was 74 years and critical lower limb ischemia was present in 87% of the patients at admission. Intestinal flora was cultivated in 74% of the wounds. VAC associated bleeding occurred in four patients. Complete wound healing was achieved in 66%. Deep groin infections were associated with synthetic graft infection (P<0.001), treatment outside hospital (P<0.001), faster healing (P<0.01) and lower amputation rate (P<0.005). Diabetes mellitus (OR 2.7; [95% CI 1.2-6.2]) and foot wound (OR 3.0; [95% CI 1.2-7.4]) were independent predictors for amputation. The absence of complete wound healing was the strongest factor for both amputation (P<0.001) and death (P<0.001). CONCLUSIONS: VAC therapy of complex wounds in the lower limbs in patients with vascular disease was associated with high healing rates. Non-healed wounds after VAC therapy were predictors for amputation and death.
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| 24. |
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| 25. |
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| 26. |
- Persson, Sylvi Ulrika
(författare)
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Blood pressure reactions to insulin treatment in patients with type 2 diabetes
- 2007
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Ingår i: International Journal of Angiology. - New York, USA : Pulsus Group Inc.. - 0392-9590 .- 1827-1839. ; 16:4, s. 135-138
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Tidskriftsartikel (refereegranskat)abstract
- Abstract BACKGROUND: The institution of insulin therapy may be easy and uncomplicated in some Type 2 diabetics, but in others, mainly the obese patients, problems often arise (e.g. poor compliance, worsening B-cell function and/or insulin resistance). METHODS: As a substudy of a broader investigation, concerning hemorheological effects of insulin treatment in insufficiently controlled type 2 diabetics, blood pressure was recorded in 12 patients at baseline, after two months and after four months on insulin. RESULTS: After two months on insulin analyses of triglycerides, high density lipoprotein cholesterol and total cholesterol indicated metabolic improvement (p<0.05 to 0.001) and a surprisingly uniform increase of blood pressure values (p<0.05 to 0.01) was found. At the same time, the serum sodium concentration increased (p<0.01) and was positively correlated to both systolic and diastolic blood pressure (p<0.01). After four months on insulin, blood pressure returned to pre-treatment values or even lower (p<0.05 to 0.01). Serum sodium also decreased to pretreatment values. No significant changes of the flow behaviour of blood were seen after institution of insulin. CONCLUSIONS: The number of patients was small and the study was not primarily designed to examine blood pressure. The preliminary conclusion from this study, however, is that the initiation of insulin treatment in poorly controlled type 2 diabetics causes a temporary and possibly clinically significant elevation of blood pressure. A changed renal handling of sodium caused by insulin, may be one of several possible explanations to the results, but further studies are warranted to confirm the findings. Key words: Blood pressure; Insulin therapy; NIDDM; Sodium excretion.
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| 27. |
- Singh, Bharti, et al.
(författare)
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Simple diameter measurements with ultrasound can be safely used to follow the majority of patients after infrarenal endovascular aneurysm repair
- 2021
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Ingår i: International Angiology. - 0392-9590. ; 40:5, s. 425-434
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Forskningsöversikt (refereegranskat)abstract
- Background: The optimal imaging follow-up after infrarenal EVAR is still undefined. The aim of this study was to analyze the outcome of a personalized follow-up program after infrarenal EVAR based on ultrasound AAA diameter measurements for low-risk patients. Methods: All consecutive patients followed-up locally after elective and acute infrarenal EVAR between 2010 and 2015 were retrospectively reviewed. Patients underwent CTA at 1-month post-EVAR whereby the attending surgeon defined the subsequent follow-up. Patients considered at low risk were followed with ultrasound only assessing AAA diameter at 1, 2, 3 and every 5 years postoperatively (group A). Low risk required a favorable pre-operative anatomy especially regarding the aneurysm neck, satisfactory intraoperative result and uneventful 1 month CTA (type 2 endoleaks acceptable). Patients not fulfilling the criteria for group A were followed with yearly 3-phase-CTAs (group B). Results: Two hundred twenty-two patients with a AAA median diameter of 58 (54-68) mm were included. One hundred ninety-one were allocated into group A and 31 in group B. Median follow-up time was 36 (24-59) months. Five-year primary and primary-assisted success was 82±5% and 93±3% for group A and 70±13% and 93±5% for group B, respectively (P=0.042 and P=0.504, respectively). Sixteen late aneurysm-related reinterventions were performed in 12 patients (7 in group A and 9 in group B). In group A, 5 reinterventions were rupture-preventing and 2 were symptomatic. All late reinterventions in group B were performed following findings on follow-up imaging. Five-year late reintervention-free survival was 95±2% and 84±7% for groups A and B, respectively (P=0.046). Five-year survival was 80±3% and 63±10% for group A and B, respectively (P=0.024). Conclusions: A customized follow-up program after infrarenal EVAR based on ultrasound AAA diameter measurements in low-risk patients seems to be effective in maintaining a very high mid-term clinical success rate.
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| 28. |
- Acosta, Stefan, et al.
(författare)
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Endovascular therapy for visceral artery aneurysms.
- 2015
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Ingår i: International Angiology. - 1827-1839. ; 35:6, s. 573-578
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Tidskriftsartikel (refereegranskat)abstract
- The aim of this study was to report outcome and complications of endovascular therapy for visceral artery aneurysms (VAA).
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| 29. |
- Alhadad, Alaa, et al.
(författare)
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Medical risk factor treatment in peripheral arterial disease. Need for further improvement.
- 2013
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Ingår i: International Angiology. - 1827-1839. ; 32:3, s. 332-338
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Tidskriftsartikel (refereegranskat)abstract
- Aim: Risk factors for development of peripheral arterial disease (PAD) are the same as for atherosclerotic coronary or precerebral disease, and patients with PAD have a high prevalence of concomitant atherosclerotic disease in coronary and precerebral arteries. However, these patients are still less likely to receive appropriate pharmacological secondary prevention than patients with coronary artery disease. The aim of this study was to evaluate the treatment of risk factors for patients undergoing open or endovascular surgery for PAD in our vascular department. Methods: We evaluated pharmacological treatment, lipid levels, blood pressures (BP), and smoking habits one month postoperatively in 953 patients (age [mean ± SD] 71±11 years, 524 [55%] men) undergoing open or endovascular surgical interventions for PAD. Results: We found that 89% of patients received statins and 98% received either platelet aggregation inhibitors or anticoagulants at the one month follow-up. Four hundred nineteen (70%) patients had achieved target level <4.5 mmol/L for s-total cholesterol, and 394 (67%) target level <2.5 mmol/L for s-LDL cholesterol. BP (mean ± SD) was 144±22/76±12 mmHg, systolic and diastolic target BPs (<140 mmHg and <90 mmHg, respectively) were achieved in 482 (51%) and 887 (95%) patients, respectively. The proportion of active smokers had been reduced from 41% preoperatively to 24% at the one month follow-up (P<0.0001). Conclusion: Even though our practice has improved, there is still room for better follow-up of pharmacological risk factor treatment in PAD patients.
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| 30. |
- Alhadad, Alaa, et al.
(författare)
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Predictors of long-term beneficial effects on blood pressure after percutaneous transluminal renal angioplasty in atherosclerotic renal artery stenosis.
- 2009
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Ingår i: International Angiology. - 1827-1839. ; 28:2, s. 106-112
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Tidskriftsartikel (refereegranskat)abstract
- AIM: This retrospective study evaluated long-term effects of percutaneous transluminal renal angioplasty (PTRA) in atherosclerotic renal artery stenosis (ARAS), and predictors of benefit on blood pressure (BP). METHODS: During 1997-2003, 234 patients (age 69+/-11 years, 138 [59%] males) underwent PTRA for ARAS at Malmö Vascular Centre. Cure was defined as diastolic (D)BP<90 mmHg and systolic (S)BP <140 mmHg off antihypertensive medication. Improvement was defined as DBP <90 mmHg and/or SBP <140 mmHg on the same or reduced number of medications, or reduction in DBP of 15 mmHg with the same or reduced number of medications. Benefit was defined as cure or improvement. RESULTS: After PTRA, SBP and DBP decreased (P<0.001), and remained lower (P<0.001) until last follow-up after 4.1+/-3.3 years. Antihypertensive medication decreased (P<0.001), and remained lower at one month (P<0.001), one year (P<0.01), and last follow-up (P<0.05). Renal function was unchanged until last follow-up, when it deteriorated (P<0.001). Patients showing benefit of PTRA on BP at last follow-up (N.=150 [64%]) used more antihypertensive drugs before PTRA (P=0.012), especially angiotensin converting enzyme inhibitors (ACEi) or angiotensin II receptor blockers (ARBs) (P=0.010), and diuretics (P=0.015). In logistic regression, use of ACEi or ARBs failed to reach significancy (P=0.054). Patients dying during follow up (N.=100 [43%]) showed higher age (P<0.0001) and s-creatinine (P<0.0001), lower glomerular filtration rate (P<0.0001), and higher frequency of diabetes mellitus (P<0.005). In logistic regression only age (P=0.009) and diabetes mellitus (P=0.014) predicted mortality. CONCLUSIONS: We confirmed beneficial effects on BP with PTRA in ARAS. ACEi, ARB and diuretic treatment before PTRA predict favourable long-term BP-response in univariate analysis.
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| 31. |
- Anwaar, I., et al.
(författare)
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Intraplatelet cyclic 3'-5' guanosine monophosphate is related to serum cholesterol
- 1996
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Ingår i: International Angiology. - 0392-9590. ; 15:3, s. 201-206
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Tidskriftsartikel (refereegranskat)abstract
- Nitric oxide (NO) exerts its vasodilator and antiaggregatory effects through activation of soluble guanylate cyclase and the consequent increase in the concentration of cGMP in target cells. We conducted this study in order to evaluate relationships between intraplatelet cGMP levels and risk factors for atherosclerosis in middle aged subjects. Intraplatelet cGMP was determined by radioimmunoassay and related to age, BMI, blood pressure, antihypertensive treatment, total, LDL and HDL cholesterol, triglycerides, blood glucose, HbA1c, smoking habit and intimal thickness of the common carotid artery in 265 subjects participating in a health survey (age 59 ± 6 years, range 48-68 years, 121 females, 144 males). Intraplatelet cGMP concentration was inversely correlated with total serum cholesterol (r = -0.18; p < 0.01) and HDL cholesterol (r = -0.14, p < 0.05) as well as with platelet count (r = -0.29; p < 0.001). When platelet count was adjusted for, only the correlation between total serum cholesterol and cGMP remained significant. No significant correlations could be demonstrated between intraplatelet cGMP levels and measurable parameters of atherosclerosis. Lower levels of the vasodilating and antiaggregating mediator cGMP in platelets are related to higher levels of serum total cholesterol. These results favour the hypothesis of a relationship between lipid levels and NO associated vasodilator and antiaggregating fuction in atherosclerosis.
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| 32. |
- Asciutto, Giuseppe, et al.
(författare)
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Long-term progression of contralateral carotid artery disease after endarterectomy: is there a need for Duplex surveillance?
- 2012
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Ingår i: International Angiology. - 1827-1839. ; 31:4, s. 361-367
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Tidskriftsartikel (refereegranskat)abstract
- AIM: The aim of this paper was to define the incidence of disease progression of the contralateral internal carotid artery (CICA) in patients undergoing carotid endarterectomy (CEA) and to identify factors influencing disease progression. METHODS: Patients from our primary catchment area that had undergone CEA between 2002 and 2005 were included. The study cohort was divided in four groups based on the preoperative stenosis grade (normal ICA <40%, N.=56; mild 40-60%, N.=41; moderate 61-80%, N.=12; severe 81-99%, N.=7). Patients initially planned or already submitted to contralateral CEA or with contralateral occlusion were excluded. RESULTS: One hundred and seventeen patients were analysed. Disease progression occurred in 13 (11%) patients after a mean of 47.6 months (SD 1.6 months). A moderate preoperative CICA stenosis was associated with disease progression (P=0.017). Late neurologic events referable to the CICA independently of progression occurred in 13 (11%) patients. There were 4 (30.7%) events in the 13 carotids with progression and only 9 (7%) in the 117 without progression (P=0.060). .Moderate and severe preoperative CICA stenosis and renal insufficiency were associated with postoperative ipsilateral neurological symptoms (P=0.001 and 0.009, respectively). CONCLUSION: Disease progression of the CICA after CEA is not uncommon. The preoperative degree of CICA stenosis is related to subsequent disease progression and to the occurrence of symptoms. More studies are needed to identify risk factors influencing the progression of ICA disease.
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| 33. |
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| 34. |
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| 35. |
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| 36. |
- Bertz, L, et al.
(författare)
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Are there differences of inflammatory bio-markers between diabetic and non-diabetic patients with critical limb ischemia?
- 2006
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Ingår i: International Angiology. - 1827-1839. ; 25:4, s. 370-377
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Tidskriftsartikel (refereegranskat)abstract
- Aim. This observational study was undertaken in order to analyse whether any differences could be detected between diabetic and non-diabetic patients with critical limb ischemia (CLI) concerning the inflammatory response. Methods. A total number of 259 consecutive patients with CLI were treated between October 2001 and January 2003. Results. Among the 259 patients, 135 (52%) had diabetes, previously known in 123, and detected during hospitalization in 12. The diabetic patients more often showed gangrene (P < 0.05) and infra-inguinal atherosclerosis (84% vs 67%, P=0.001). The patients with diabetes showed a better lipid profile (total cholesterol 4.6 vs 5 mmol/L, P=0.006 and lower LDL-cholesterol (2.7 vs 3.1 mmol/L, P=0.010) despite the same frequency of statin treatment. They showed a higher creatinine (149 vs 117 pmol/L, P=0.0003) than the nondiabetic patients. Of the inflammatory markers, C-reactive protein (CRP) was equally elevated in both groups. Tumor necrosis factor-a (TNF-a) was increased among the diabetic patients (2.6 vs 1.8 pg/mL, P < 0.05), and this difference was most evident in those with gangrene. Neopterin was also higher among the diabetic patients (31 vs 21 mmol/L, P < 0.01), but CD40L was not different between groups. Conclusions. Diabetes mellitus was very common in CLI patients, and more often combined with renal impairment and infra-inguinal atherosclerosis. The inflammatory markers TNF-alpha and neopterin were elevated in patients with diabetes as compared to non-diabetic patients, but this difference cannot explain why CLI is 10 times more frequent in diabetic patients.
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| 37. |
- Bodelsson, Mikael, et al.
(författare)
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Effect of cooling on vascular smooth muscle response to endothelin-1 in human and rat veins
- 1997
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Ingår i: International Angiology. - 1827-1839. ; 16:4, s. 262-268
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: The plasma level of endothelin-1 is locally increased during cooling but the net vasoconstrictor effect will be dependent on temperature effects on the vascular smooth muscle reactivity in response to the polypeptide. The aim of this study was to investigate the effect of cooling on the vascular smooth muscle response to endothelin-1 in human and rat veins. METHODS: Registration of vascular smooth muscle activity in vitro in vessel preparations from normal subjects. SETTING: Laboratory. PATIENTS AND ANIMALS: Superficial hand veins from 14 patients undergoing hand surgery and external jugular veins from 14 rats. INTERVENTIONS: Effects of endothelin-1, after denudation of the endothelium and during cooling, were compared with controls without these interventions. RESULTS: At 37 degrees C, endothelin-1 induced a concentration-dependent contraction in the human hand and rat jugular veins. The sensitivity to endothelin-1 was enhanced in segments without endothelium. At 37 degrees C, no relaxation in response to endothelin-1 was observed. Cooling to 10 degrees C did not alter precontraction achieved by endothelin-1 at 37 degrees C in the human hand veins, while it depressed the precontraction in the rat jugular vein. The effect of cold was reversible. Removal of the endothelium did not alter the response to cooling. CONCLUSIONS: The maintained reactivity in response to endothelin-1 during cooling of the human vessels suggests that the reported increase in endothelin-1 levels due to local cooling could contribute in the pathophysiology of peripheral vasospasm in humans.
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| 38. |
- Catalano, M, et al.
(författare)
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Requirements for angiology/vascular medicine
- 2013
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Ingår i: International angiology : a journal of the International Union of Angiology. - 1827-1839. ; 32:6, s. 608-612
-
Tidskriftsartikel (refereegranskat)
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| 39. |
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| 40. |
- Claesson, K, et al.
(författare)
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Role of endovascular intervention in patients with diabetic foot ulcer and concomitant peripheral arterial disease.
- 2011
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Ingår i: International Angiology. - 1827-1839. ; 30:4, s. 349-358
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Tidskriftsartikel (refereegranskat)abstract
- AIM: The aim of this study was to evaluate wound healing, major amputation and mortality in patients with diabetic foot ulcer and peripheral arterial disease (PAD), and to compare the group decided to have an endovascular intervention with groups referred to conservative treatment or to those judged as unreconstructable. METHODS: A retrospective two-year review of all patients with diabetic foot ulcers and PAD presented at an interdisciplinary diabetic foot round 2006-2007 at Malmö University Hospital, Sweden, was performed. Independent predictive factors of insufficient ulcer healing, amputation and mortality during follow-up were analysed according to treatment decisions at the diabetic foot round. RESULTS: A total of 135 limbs in 115 consecutive diabetic patients with foot ulcers were included. Median age was 73 years and 41% were women. During a median follow-up time of 17 months, 44% of the ulcers did not heal, 15% of the limbs underwent major amputation and 42% died. Ulcer depth with a Wagner grade ≥3 (hazard ratio [HR] 5.8; 95% confidence interval [CI] 2.6-12.9), CRP (HR 1.007; 95% CI 1.002-1.012, and impaired run-off (HR 3.0; 95% CI 1.03-8.9) were independent risk factors for incomplete wound healing. The three treatment decision groups: attempt for endovascular leg revascularization (N.=75), conservative (N.=42) and unreconstructable (N.=18) showed no significant difference in terms of wound healing, major amputation or death. CONCLUSION: Patients with diabetic foot ulcers and concomitant PAD are at high risk for limb loss and premature death. Ulcer depth, CRP and impaired run-off are independent risk factors for incomplete wound healing. There is an apparent need for prospective controlled studies to better define the role of endovascular therapy in this subset of diabetic foot ulcer patients.
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| 41. |
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| 42. |
- Dahl, O. E., et al.
(författare)
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Major joint replacement. A model for antithrombotic drug development: from proof-of-concept to clinical use
- 2008
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Ingår i: International angiology. - 0392-9590. ; 27:1, s. 60-7
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Tidskriftsartikel (refereegranskat)abstract
- AIM: Development of antithrombotic compounds has traditionally been performed in patients undergoing total hip and knee replacement surgery. A high number of asymptomatic deep-vein thromboses are radiologically detectable, and bleeding and other adverse events (AE) are easy to observe. However, standardization of study procedures and endpoints in early proof-of-concept studies and late pure clinical endpoint studies has been lacking. This has made comparison between studies difficult, economic analyses speculative and potential benefits of applying the drug regimen in non-selected patients uncertain. In this paper, the International Surgical Thrombosis Forum proposes a strategy for the clinical investigation of new pharmacological agents for the prophylaxis of postoperative thrombotic events. METHODS: First, dose titration safety studies of short duration, in highly selected patients using objective venographic endpoints are recommended. Bleeding should be divided into the quantified volume of surgical bleeding and other adjudicated clinical bleeding events. The number of AE should be described for each dose step and classified according to International Coding of Diagnoses (ICD). Second, a dose confirmatory study of moderate exposure period and sufficient follow-up time is recommended. The exclusion criteria should be restricted to contraindications of the compared drugs and technical procedure. RESULTS: The efficacy, bleeding and AE should be similar to those used in dose-titration studies. In addition, the failure rate of the drug to exert its effect and the net clinical benefit should be calculated. CONCLUSION: Finally, trials with simple clinical endpoints and long follow-up should be conducted to evaluate the potential benefits of the drug-regimen in non-selected populations.
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| 43. |
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| 44. |
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| 45. |
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| 46. |
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| 47. |
- Dias, Nuno, et al.
(författare)
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Hemodynamics and jugular venous oxygen saturation during carotid endarterectomy: a comparison between general and locoregional anesthesia.
- 2010
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Ingår i: International Angiology. - 1827-1839. ; 29:3, s. 232-238
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Tidskriftsartikel (refereegranskat)abstract
- AIM: To study hemodynamic and blood oxygenation changes in patients undergoing carotid endarterectomy (CEA) under general (GA) or locoregional (LRA) anesthesia. METHODS: Prospective non-randomized study including 50 patients undergoing CEA (31 men, mean age 72 (range 50-84) years-old under GA (N.=23) or LRA (N.=27). Systemic blood pressure, ECG, venous oxygen saturation in the ipsilateral jugular bulb and pulse-oximetry were monitored. Blood-gas analysis was done from blood obtained from the radial artery and ipsilateral jugular vein. RESULTS: Pulse rate and systemic systolic blood pressure were higher in LRA compared to the GA before, during and after cross clamping (P<0.05). Seven GA patients required dopamine-infusion to maintain systolic blood pressure >120 mmHg. Jugular venous saturation was initially identical in both groups, but decreased significantly upon cross clamping in LRA compared to GA (P<0.05). This difference remained at least 3 minutes after cross clamp release (P<0.05). CONCLUSION: Patients under LRA seem to have increased sympathetic activity compared to patients under GA, as expressed by higher pulse rates and systolic blood pressures. Jugular venous saturation was lower during clamping of LRA patients. The differences were small and concur with the near-equality findings in studies analysing the clinical outcome.
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| 48. |
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| 49. |
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| 50. |
- Elmstahl, S., et al.
(författare)
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Hydrotherapy of patients with intermittent claudication : A novel approach to improve systolic ankle pressure and reduce symptoms
- 1995
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Ingår i: International Angiology. - 0392-9590. ; 14:4, s. 389-394
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Tidskriftsartikel (refereegranskat)abstract
- Objective. To study the effects of alternating cold and hot water therapy on walking ability and systolic blood pressure in claudicants. Experimental design. A prospective case study with repeated measurements before and 1, 4 and 12 months after treatment. The systolic blood pressure levels were measured with an occlusion cuff for brachial and ankle and with a strain gauge for the first toe. Study population. Twenty consecutively included patients, 11 women and 9 men; mean age 73.9 yrs, with intermittent claudication according to clinical examination and ankle-arm systolic blood pressure (AAI) below 0.90. Intervention. Alternate hot and cold hydrotherapy of the legs were given at ten 25-minute treatments during a three-week period. The outcome measures were maximal walking ability (MW), walking ability before pain (PW) and systolic blood pressures of toe, ankle, arm and AAI. Results. Fourtheen patients (70%) reported reduced pain after treatment and their PW increased from 134 ± 29 m to 415 ± 119 m 12 months later (p < 0.05) and the MW in the total group increased form 348 ± 75 m to 523 ± 103 m. Systolic blood pressure increased in right ankle and toe one month after treatment in the total group. Among those who reported improved walking ability one year after treatment, systolic blood pressure in both right and left ankles and toes increased; e.g. right toe increasing from 72 ± 7 to 86 ± 2 (p < 0.001). Improvements of systolic blood pressure in left and right leg and changes of walking ability were correlated, in the order of 0.60 to 0.81, p < 0.05. Conclusions. Showering the legs of claudicants improved walking ability and blood pressures which sustained up to 1-year later. This therapy might be an additional alternative to conservative treatment of intermittent claudication.
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