| 1. |
- 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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| 2. |
- Arzola, Luis H., et al.
(författare)
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Outcome of a dedicated complex aortic surgery fellowship program
- 2024
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Ingår i: Frontiers in Surgery. - : Frontiers Media S.A.. - 2296-875X. ; 11
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Tidskriftsartikel (refereegranskat)abstract
- Introduction: Advancements in endovascular therapy, especially in complex aortic procedures, underscore the need for additional post-certification training. Dedicated post-residency vascular fellowship programs offer exposure to diverse cases, research opportunities, and professional networking. The study aims to describe and present outcomes from the complex aortic fellowship program at the Vascular Surgery Department of the Uppsala University Hospital.Methods: Nine former fellows who completed the aortic fellowship program at the Uppsala University Hospital from 2018 to 2023 were invited to take part in an anonymous 29-question survey through email. Demographic data, information about the existence of local aortic programs as well as on the types of aortic procedures performed were gained. The overall experience and impact of the fellowship were assessed using multiple interval scale questions, with a rating scale (1 excellent to 5 very poor). Finally, we provided the option to the participants to share additional feedback.Results: Median age of participants was 34 years (IQR, 30.5-36), with 44.4% being women (4/9). There was a significant variation in the number of publications produced during the fellowship, with an overall mean of 4 papers (IQR, 2-10). Regarding the long-term impact of the fellowship, 5/9 (55.6%) of the fellows have contributed to the implementation of a complex aortic program after finishing the fellowship, providing a broad range of complex aortic procedures. All fellows (9/9, 100%) stated that the quality of the fellowship was excellent. The clinical experience 7/9 (77.8%), the academic environment 7/9 (77.8%) and the research opportunities 7/9 (77.8%) together with the mentorship 9/9 (100%) and the work environment 8/9 (88.9%), were considered of most value among the fellows. In general, the survey participants agreed that the fellowship atmosphere was suitable for learning, 9/9 (100%), and that it had a positive impact on their current practice, 7/9 (77.8%). Currently, 5/9 (55.5%) of the fellows hold a position including academic involvement.Conclusions: There is a universal need for additional post-certification training. The current study showed that a balanced clinical and scientific exposure to complex aortic diseases is broadly welcomed among young vascular surgeons. The extension of the fellowship to cover other disciplines dealing with complex aortic procedures can be of value.
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| 3. |
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| 4. |
- Asciutto, Giuseppe
(författare)
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Carotid stenosis: aspects on progression, stabilization and follow-up
- 2014
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Cardiovascular (CV) atherosclerotic diseases are the leading cause of death in Western nations. The presence of a carotid plaque, the degree of carotid stenosis as well as the rate of progression of carotid disease has been shown to be independent predictive factors for future ischemic events. The aim of this thesis was to detect clinical, sonographic and serologic patterns that could aid in identifying patients at risk of progression of atherosclerosis and the development of symptoms; the thesis also focuses on the role of current medical treatments in atherogenesis and plaque composition. In this thesis we demonstrate a high incidence of symptoms and disease progression contralateral to the carotid artery treated by endarterectomy, particularly in the presence of a moderate (i.e. >60%) stenosis degree at baseline. As evidence of possible protective effects on atherogenesis by beta-blockers grows, we decided to analyse plaque content of two factors involved in regulating the inflammatory process leading to the atherogenesis. Focusing on the soluble urokinase plasminogen activator receptor and the lipoprotein associated phospholipase A2 we detected a lower level of inflammation in patients on long-term treatment with beta-blockers. These findings were in line with a higher echogenicity of carotid plaques as evaluated using grey-scale median (GSM) analysis in patients on long-term treatment with beta-blockers. Finally, assessing possible preoperative plaque and serological markers we observed higher risk for postoperative stroke in patients with lower elastin plaque content and a higher risk of CV death in patients with lower circulating titers of antibodies of type IgG against the epitope p210 of the apolipoprotein B100 of LDL In conclusion, this thesis underlines that progression of contralateral disease after unilateral CEA occurs frequently. Moreover, it reinforces the possible atheroprotective effects of beta-blockers beyond the purely hemodynamic and the need to monitor the effects with non-invasive diagnostic tools. It also supports the concept that ECM proteins are important for plaque stability and suggest the potential of the assessment of Ab against oxLDL as a supplemental marker of generalised atherosclerosis. Further studies are needed to better identify high risk populations that are in need of more intensive secondary prevention
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| 5. |
- 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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| 6. |
- Asciutto, Giuseppe, et al.
(författare)
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E-nside, a New Kid on the Aortic Block
- 2023
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Ingår i: European Journal of Vascular and Endovascular Surgery. - : Elsevier. - 1078-5884 .- 1532-2165. ; 65:6, s. 818-818
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)
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| 7. |
- 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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| 8. |
- Asciutto, Giuseppe, et al.
(författare)
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Grafts Outside the United States
- 2021
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Ingår i: Complications in Endovascular Surgery : Peri-Procedural Prevention and Treatment - Peri-Procedural Prevention and Treatment. - 9780323554497 - 9780323554480 ; , s. 83-85
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Bokkapitel (refereegranskat)abstract
- The market of aortic endografts is in continuous development. Several endografts that have gained the CE mark are under investigation by the FDA before launching in the US market. This chapter describes their peculiarities and the evidence acquired with the use of these endografts. Since the majority of the devices described in this chapter have been recently introduced, the evidence on the feasibility of their use in the treatment of aortic aneurysm is limited. The available data report of short-term results in terms of patency, freedom from Types I and III endoleak (EL), and freedom from aneurysm sac enlargement is comparable to those of devices that have been longer in use.
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| 9. |
- Asciutto, Giuseppe, et al.
(författare)
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Intravascular ultrasound in the detection of bridging stent graft instability during fenestrated and branched endovascular aneurysm repair procedures : a multicentre study on 274 target vessels
- 2024
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Ingår i: European Journal of Vascular and Endovascular Surgery. - : Elsevier. - 1078-5884 .- 1532-2165. ; 67:1, s. 99-104
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Tidskriftsartikel (refereegranskat)abstract
- Objective: The use of intravascular ultrasound (IVUS) reduces contrast medium use and radiation exposure during conventional endovascular aneurysm repair (EVAR). The aim of this study was to evaluate the safety and efficacy of IVUS in detecting bridging stent graft (bSG) instability during fenestrated and branched EVAR (F/B-EVAR).Methods: This was a prospective observational multicentre study. The following outcomes were evaluated: (1) technical success of the IVUS in each bSG, (2) IVUS findings compared with intra-operative angiography, (3) incidence of post-operative computed tomography angiography (CTA) findings not detected with IVUS, and (4) absence of IVUS related adverse events. Target visceral vessel (TVV) instability was defined as any branch or fenestration issues requiring an additional manoeuvre or re-intervention. Any IVUS assessment that detected stenosis, kinking, or any geometric TVV issue was considered to be branch instability. All procedures were performed in ad hoc hybrid rooms.Results: Eighty patients (69% males; median age 72 years; interquartile range 59, 77 years) from four aortic centres treated with F/B-EVAR between January 2019 and September 2021 were included: 70 BEVAR (21 off the shelf; 49 custom made), eight FEVAR (custom made), and two F/B-EVAR (custom made), for a total of 300 potential TVVs. Two TVVs (0.7%) were left unstented and excluded from the analysis. The TVVs could not be accessed with the IVUS catheter in seven cases (2.3%). Furthermore, 17 (5.7%) TVVs could not be examined due to a malfunction of the IVUS catheter. The technical success of the IVUS assessment was 91.9% (274/298), with no IVUS related adverse events. Seven TVVs (2.5%) showed signs of bSG instability by means of IVUS, leading to immediate revisions. The first post-operative CTA at least 30 days after the index procedure was available in 268 of the 274 TVVs originally assessed by IVUS. In seven of the 268 TVVs (2.6%) a re-intervention became necessary due to bSG instability.Conclusion: This study suggests that IVUS is a safe and potentially valuable adjunctive imaging technology for intra-operative detection of TVV instability. Further long term investigations on larger cohorts are required to validate these promising results and to compare IVUS with alternative technologies in terms of efficiency, radiation exposure, procedure time, and costs.
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| 10. |
- 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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| 11. |
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| 12. |
- Asciutto, Giuseppe, et al.
(författare)
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Low elastin content of carotid plaques is associated with increased risk of ipsilateral stroke.
- 2015
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Ingår i: PLoS ONE. - : Public Library of Science (PLoS). - 1932-6203. ; 10:3
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Tidskriftsartikel (refereegranskat)abstract
- Atherosclerotic plaques with a low content of connective tissue proteins are believed to have an increased risk of rupture and to give rise to clinical events. The aim of the present study was to investigate if the content of elastin, collagen and of the matrix metalloproteinase (MMP) -1, -3, -9 and -12 in plaques removed at surgery can be associated with the occurrence of ipsilateral symptoms.
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| 13. |
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| 14. |
- Asciutto, Giuseppe, et al.
(författare)
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Subintimal Recanalization of an Occluded Common Iliac Stent : A Case Report
- 2017
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Ingår i: Annals of Vascular Surgery. - : Elsevier BV. - 0890-5096. ; 39, s. 7-293
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Tidskriftsartikel (refereegranskat)abstract
- The purpose of this report is to describe a minimally invasive alternative endovascular technique for the treatment of chronically occluded stents when it is not possible to cross them endoluminally. A 71-year-old patient with recurrent severe lower limb claudication due to occlusion of a stent placed in the common iliac artery 5 years earlier underwent subintimal recanalization of the stented segment and restenting after failed intraluminal approach. The postoperative computed tomography scan showed that the restented segment was patent with a flattening of the previous stent. Five years postoperatively the patient remains free from symptoms and the recanalized arteries are still patent at ultrasound.
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| 15. |
- Asciutto, Giuseppe, et al.
(författare)
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Treatment with beta-blockers is associated with lower levels of Lp-PLA2 and suPAR in carotid plaques.
- 2013
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Ingår i: Cardiovascular Pathology. - : Elsevier BV. - 1879-1336 .- 1054-8807. ; 22:6, s. 438-443
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES: To determine whether a long-term treatment with beta-blockers influences the inflammatory activity in carotid artery disease by reducing the carotid plaque levels of lipoprotein-associated phospholipase A2 (Lp-PLA2), its enzymatic products lysophosphatidylcholine (lysoPCs), and of soluble urokinase plasminogen activator receptor (suPAR). MATERIALS AND METHODS: One hundred and thirty-four patients with significant symptomatic or asymptomatic carotid stenosis undergoing surgery were prospectively included and divided into two groups (Group A or B) based on the absence or presence of an on-going long-term oral treatment with beta-blockers. The harvested carotid plaques were analyzed for the levels of lysoPCs using mass spectrometry and Lp-PLA2 and suPAR by Enzyme-linked immunosorbent assay (ELISA). RESULTS: Plaques of patients on long-term treatment with beta-blockers revealed lower levels of Lp-PLA2 (Group A 0.752±0.393 ug/g vs. Group B 0.644±0.445 ug/g, P=.049) as well as suPAR (Group A 0.044±0.024 μg/g vs. Group B 0.036±0.025 μg/g, P=.028). Levels of Lp-PLA2 and suPAR were positively correlated (r=.637, P<.0001). Lp-PLA2 and suPAR levels were also correlated (P<.0001) with the three lysoPC species tested (lysoPC 16:0, lysoPC 18:0. lysoPC 18:1). All the above-mentioned findings were confirmed after correction for age, gender, hypertension, coronary artery disease, and statin usage. CONCLUSIONS: The reduced levels of Lp-PLA2 and suPAR in human carotid plaques of subjects on long-term treatment with beta-blockers suggest their possible protective role in plaque inflammation. Our findings support an even more selective Lp-PLA2 and suPAR inhibition as a possible strategy for the prevention of cardiovascular disease.
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| 16. |
- Asciutto, Giuseppe, et al.
(författare)
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Treatment with betablockers is associated with higher grey-scale median in carotid plaques
- 2014
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Ingår i: BMC Cardiovascular Disorders. - : Springer Science and Business Media LLC. - 1471-2261. ; 14
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Tidskriftsartikel (refereegranskat)abstract
- Background: The presence of echolucent carotid plaques as defined by low ultrasound grey-scale median (GSM) is associated with a higher risk of stroke and myocardial infarction. Betablockers have shown possible anti-atherosclerotic effects. The aim of the present study was to determine if there is an association between carotid plaque GSM and treatment with betablockers. Methods: The GSM of the carotid plaques of 350 patients who underwent carotid endarterectomy (CEA) for asymptomatic (n = 113) or symptomatic (n = 237) carotid disease was measured. Patients were divided in two groups based on the absence/presence of an on-going long-term (i.e. at least 6 months) oral treatment with betablockers at the time of CEA. Results: The prevalence and type of preoperative neurological symptoms were similar in the two groups. Patients with betablockers had more frequently arterial hypertension (P < .0001), diabetes (P = .035) and a higher BMI (P = .0004), while patients without betablockers were most frequently smokers (P = .017). Patients with betablockers revealed to have higher GSM (37.79 +/- 25 vs 32.61 +/- 23.50 P = .036). Echogenic plaques (i.e. with GSM > 30) showed to be more frequent in patients with betablockers also after correction for age, gender, the occurrence of preoperative symptoms, diabetes, hypertension, smoking and statins use (P = .024). Conclusions: These results suggest the use of standardized ultrasound techniques as an important tool in evaluating the effect of anti-atherosclerotic medications and underline the need of. further prospective randomized studies on larger patient cohorts in order to confirm these results.
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| 17. |
- Bengtsson, Eva, et al.
(författare)
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ADAMTS-7 is associated with a high-risk plaque phenotype in human atherosclerosis
- 2017
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Ingår i: Scientific Reports. - : Springer Science and Business Media LLC. - 2045-2322. ; 7:1
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Tidskriftsartikel (refereegranskat)abstract
- Several large-scale genome-wide association studies have identified single-nucleotide polymorphisms in the genomic region of A Disintegrin And Metalloproteinase with ThromboSpondin type 1 repeats (ADAMTS)-7 and associations to coronary artery disease. Experimental studies have provided evidence for a functional role of ADAMTS-7 in both injury-induced vascular neointima formation and development of atherosclerotic lesions. However, whether ADAMTS-7 is associated with a specific plaque phenotype in humans has not been investigated. Carotid plaques (n = 206) from patients with and without cerebrovascular symptoms were analyzed for expression of ADAMTS-7 by immunohistochemistry and correlated to components associated with plaque vulnerability. Plaques from symptomatic patients showed increased levels of ADAMTS-7 compared with lesions from asymptomatic patients. High levels of ADAMTS-7 correlated with high levels of CD68-staining and lipid content, but with low smooth muscle cell and collagen content, which together are characteristics of a vulnerable plaque phenotype. ADAMTS-7 levels above median were associated with increased risk for postoperative cardiovascular events. Our data show that ADAMTS-7 is associated with a vulnerable plaque phenotype in human carotid lesions. These data support previous observations of a potential proatherogenic role of ADAMTS-7.
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| 18. |
- Edsfeldt, Andreas, et al.
(författare)
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Circulating cytokines reflect the expression of pro-inflammatory cytokines in atherosclerotic plaques.
- 2015
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Ingår i: Atherosclerosis. - : Elsevier BV. - 1879-1484 .- 0021-9150. ; 241:2, s. 443-449
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Tidskriftsartikel (refereegranskat)abstract
- Inflammation is a key factor in the development of plaque rupture and acute cardiovascular events. Although imaging techniques can be used to identify vulnerable atherosclerotic plaques, we are lacking non-invasive methods, such as plasma markers of plaque inflammation that could help to identify presence of vulnerable plaques. The aim of the present study was to investigate whether increased plasma levels of pro-inflammatory cytokines reflects inflammatory activity within atherosclerotic plaques.
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| 19. |
- Edsfeldt, Andreas, et al.
(författare)
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High Plasma Levels of Galectin-3 Are Associated with Increased Risk for Stroke after Carotid Endarterectomy.
- 2016
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Ingår i: Cerebrovascular Diseases. - : S. Karger AG. - 1421-9786 .- 1015-9770. ; 41:3-4, s. 199-203
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Tidskriftsartikel (refereegranskat)abstract
- Galectin-3 (Gal-3) has been suggested to have both pro- and anti-atherogenic properties. High plasma Gal-3 levels are associated with increased risk for cardiovascular (CV) death. However, it has so far not been investigated if plasma Gal-3 levels can predict the risk for future stroke in patients suffering from carotid atherosclerosis. The aim of this study was to investigate whether Gal-3 could be used as a marker to predict postoperative cerebrovascular ischemic events among patients who underwent carotid endarterectomy (CEA).
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| 20. |
- Edsfeldt, Andreas, et al.
(författare)
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Proinflammatory Role of Sphingolipids and Glycosphingolipids in the Human Atherosclerotic Plaque
- 2016
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Ingår i: Arteriosclerosis, Thrombosis and Vascular Biology. - 1524-4636. ; 36:6, s. 1132-1140
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: Lipids are central to the development of atherosclerotic plaques. Specifically, which lipids are culprits remains controversial, and promising targets have failed in clinical studies. Sphingolipids are bioactive lipids present in atherosclerotic plaques, and they have been suggested to have both proatherogenic and antiatherogenic. However, the biological effects of these lipids remain unknown in the human atherosclerotic plaque. The aim of this study was to assess plaque levels of sphingolipids and investigate their potential association with and contribution to plaque vulnerability.APPROACH AND RESULTS: Glucosylceramide, lactosylceramide, ceramide, dihydroceramide, sphingomyelin, and sphingosine-1-phosphate were analyzed in homogenates from 200 human carotid plaques using mass spectrometry. Inflammatory activity was determined by analyzing plaque levels of cytokines and plaque histology. Caspase-3 was analyzed by ELISA technique. Expression of regulatory enzymes was analyzed with RNA sequencing. Human coronary artery smooth muscle cells were used to analyze the potential role of the 6 sphingolipids as inducers of plaque inflammation and cellular apoptosis in vitro. All sphingolipids were increased in plaques associated with symptoms and correlated with inflammatory cytokines. All sphingolipids, except sphingosine-1-phosphate, also correlated with histological markers of plaque instability. Lactosylceramide, ceramide, sphingomyelin, and sphingosine-1-phosphate correlated with caspase-3 activity. In vitro experiments revealed that glucosylceramide, lactosylceramide, and ceramide induced cellular apoptosis. All analyzed sphingolipids induced an inflammatory response in human coronary artery smooth muscle cells.CONCLUSIONS: This study shows for the first time that sphingolipids and particularly glucosylceramide are associated with and are possible inducers of plaque inflammation and instability, pointing to sphingolipid metabolic pathways as possible novel therapeutic targets.
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| 21. |
- Friesen, Lia, et al.
(författare)
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Bilateral Implantation of Double-Branched Iliac Branch Devices for Endovascular Repair of Aorto-Bi-Iliac Aneurysm With Concomitant Hypogastric Aneurysms : The Quadruple Branch
- 2023
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Ingår i: Journal of Endovascular Therapy. - : Sage Publications. - 1526-6028 .- 1545-1550. ; 30:4, s. 520-524
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Tidskriftsartikel (refereegranskat)abstract
- Purpose: The purpose of this report is to describe the use of a double-branched custom-made iliac branch device (IBD) for the endovascular repair of an aorto-bi-iliac aneurysm with concomitant bilateral hypogastric aneurysms. Technique: A 61-year-old man on peritoneal dialysis underwent a computed tomography (CT) of the infrarenal aorta before planned kidney transplantation. The CT showed an asymptomatic aorto-bi-iliac aneurysm of 54 mm involving the hypogastric artery (HA) bilaterally (right HA 31 mm; left HA 40 mm). The treatment consisted of an endovascular aortic repair (EVAR) and the bilateral implantation of custom-manufactured IBDs with double inner branches to preserve both superior and inferior gluteal arteries. At 1 year follow-up, the patient remains free of symptoms and the postoperative CT showed a successfully excluded aneurysm with patent bridging stent grafts to all HA branches. Conclusion: The bilateral implantation of double-branched IBDs is a feasible technique. Preservation of both hypogastric arteries and its branches can be achieved with this technique and therefore decrease the risk of buttock claudication and other ischemic complications.
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| 22. |
- Grönberg, Caitríona, et al.
(författare)
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Endarterectomy patients with elevated levels of circulating IL-16 have fewer cardiovascular events during follow-up
- 2016
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Ingår i: Cytokine. - : Elsevier BV. - 1043-4666. ; 85, s. 137-139
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Tidskriftsartikel (refereegranskat)abstract
- Background and purpose Increased interleukin 16 (IL-16) levels in carotid plaques have been associated with reduced incidence of cardiovascular (CV) events during follow-up in patients who underwent carotid endarterectomy (CEA). In the present study we aimed to determine whether high circulating levels of IL-16 also are associated with a decreased risk of CV events after CEA. Methods Patients, who had their carotid plaques surgically removed (n = 473), were followed for a mean follow-up time of 3.1 years. Plasma levels of IL-16 the day before surgery were analyzed by proximity extension assay (PEA) and associated with the occurrence of CV events during follow-up (n = 98). Results High levels of circulating IL-16 were independently associated with a decreased risk of CV events when comparing the highest versus the lowest IL-16 tertile (hazard ratio [HR] 0.47; 95% CI 0.27–0.81; P = 0.007), as well as with CV deaths (HR 0.25; 95% CI 0.09–0.70; P = 0.008). Conclusion These present findings indicate an association between IL-16 and less clinical complications of atherosclerosis in a population with known advanced carotid disease.
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| 23. |
- Grönberg, Caitriona, et al.
(författare)
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Human Carotid Plaques With High Levels of Interleukin-16 Are Associated With Reduced Risk for Cardiovascular Events.
- 2015
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Ingår i: Stroke: a journal of cerebral circulation. - 1524-4628. ; 46:10, s. 2748-2754
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Tidskriftsartikel (refereegranskat)abstract
- Interleukin-16 (IL-16) functions as a regulator of T-cell growth and acts as an inducer of cell migration. The aim of this study was to determine whether IL-16 measured in human carotid plaques was associated with symptoms (eg, stroke, transient ischemic attack, or amaurosis fugax), markers of plaque stability, and postoperative cardiovascular events.
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| 24. |
- Halak, Sanela, et al.
(författare)
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Spotty Carotid Plaques Are Associated with Inflammation and the Occurrence of Cerebrovascular Symptoms
- 2018
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Ingår i: Cerebrovascular Diseases Extra. - : S. Karger AG. - 1664-5456. ; 8:1, s. 16-25
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Tidskriftsartikel (refereegranskat)abstract
- Background: Echolucent carotid plaques have been related to an increased risk of ischemic cerebrovascular events. The aim of the present study was to evaluate whether a new objective ultrasonographic parameter, the statistical geometric feature (SGF), reflecting spottiness of carotid plaques, can be associated with cerebrovascular symptoms and with a rupture-prone plaque phenotype. Methods: The plaques of 144 patients who underwent carotid endarterectomy were included in this study. SGF and plaque area were estimated by outlining the plaque on ultrasound (US) images. The correlation coefficient for inter- and intraobserver variability was 0.69 and 0.93, respectively. The SGF values were normalized to the degree of stenosis (SGF/DS). The plaques collected at surgery 1 day after the US were analyzed histologically, and inflammatory markers and matrix metalloproteinases (MMPs) were measured. Results: Patients with ipsilateral hemispheric symptoms had higher SGF/DS compared to patients without symptoms (0.82 [0.59–1.16] vs. 0.70 [0.56–0.89], p = 0.01). Analysis of plaque components revealed a positive correlation between SGF/DS and the percentage of the plaque area stained for lipids, macrophages, and hemorrhage. A correlation was also found between SGF/DS and plaque expression of interleukin-6, monocyte chemoattractant protein-1, macrophage inflammatory protein-1β, vascular endothelial growth factor A, C-C motif chemokine 3 and 20, and MMP-9. An inverse correlation was found with plaque levels of osteoprotegerin. Conclusions: The present study supports the concept that spottiness is a feature of the carotid plaques rich in inflammation and can be associated with the typical phenotype of high-risk plaques.
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| 25. |
- Ibrahim, Abdulhakim, et al.
(författare)
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Post-implantation syndrome after frozen elephant trunk is associated with the volume of new-onset aortic thrombus
- 2021
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Ingår i: Journal of Thoracic Disease. - : AME PUBL CO. - 2072-1439 .- 2077-6624. ; 13:7, s. 4311-4321
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Tidskriftsartikel (refereegranskat)abstract
- Background: Post-implantation syndrome (PIS) is defined as non-infectious continuous fever and a concomitant rise in inflammatory markers shortly after endovascular aortic repair. PIS occurrence after hybrid procedures, such as the frozen elephant trunk (FET) technique, has not been adequately investigated. The current study aims to define the incidence of PIS after the FET and to identify possible risk factors associated with its occurrence. Methods: The clinical charts of 59 patients undergoing the FET between February 2015 and April 2020 were reviewed retrospectively. The occurrence of PIS was defined as the presence of fever (>38 degrees C lasting longer than one day during the hospitalisation) and leucocytosis (white blood cell count >12,000/mu L). Patients with concomitant conditions possibly leading to fever and/or leucocytosis were excluded. Beside demographic and procedure-related data, serum/plasma inflammatory markers were evaluated before surgery and daily up to seven days postoperatively. Computed tomography scans (CT) were examined to calculate the volume of pre-existent and new-onset mural thrombus after the FET. Results: Thirty-eight patients met the inclusion criteria. The study cohort was divided into two groups based on the occurrence of PIS (17 cases; 44.7%). Patients with PIS were significantly younger than those without PIS (53.5 +/- 8.9 vs. 62.5 +/- 9.6 years; P=0.005). Female patients were less likely to develop PIS (5.2% vs. 26.3%, P=0.018). Patients with PIS had a higher volume of new-onset thrombus in the postoperative CT (P<0.001). Patients treated for post-dissection aneurysm had, postoperatively, significantly more thrombus material developed in a false lumen (P=0.02). Among the PIS markers, CRP (C-reactive protein) levels on the third postoperative day were independently associated with the volume of new-onset thrombus (P=0.011). After multivariate analysis, the volume of new-onset thrombus (P=0.028) and age (P=0.036) remained the variable associated with a statistically significant increased incidence of PIS. Conclusions: PIS can occur after the frozen elephant trunk procedure. The volume of new-onset thrombus seems to be associated with an increased incidence of PIS. These findings need to be confirmed in larger patient cohorts.
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| 26. |
- Lindström, David, et al.
(författare)
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Assessment of bridging stents in in situ laser fenestrations of aortic endografts with intravascular ultrasound
- 2024
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Ingår i: EJVES Vascular Forum. - : Elsevier. - 2666-688X. ; 61, s. 141-144
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Tidskriftsartikel (refereegranskat)abstract
- Objective: Treatment of complex aortic aneurysms with the in situ laser fenestration (ISLF) technique involves implantation of a balloon expandable stent graft (bSG) in the created fenestration. Adequate expansion of this bSG is of importance both to achieve seal and to ensure target vessel stability. This experimental study assessed the expansion rate of different bSGs in the ISLF setting using intravascular ultrasound (IVUS).Methods: A commercially available aortic endograft was used to test the laser fenestration technique (Zenith Alpha, Cook Medical LLC, Bloomington, IN, USA). The ISLF was stented with the following bSGs: two Gore Viabahn VBX balloon expandable endoprostheses (WL Gore & Associates, Bloomington, IL, USA), three BeGraft Peripheral and three BeGraft Plus (Bentley InnoMed GmbH; Hechingen, Germany), and three Advanta V12 (Atrium, Hudson, NH, USA). The bSGs were expanded in three steps: (1) nominal, (2) rated burst pressure, and (3) dilation with a non-compliant balloon at 15 atmospheres. After each step, an IVUS assessment of the bSG minimum diameter and the area at the fenestration (FA) and in a fully expanded segment distal to the fenestration (SA) was performed. A mean of the three IVUS measurements was used as the value for comparison. An insufficient bSG expansion was defined as a mean of FA/SA of <0.8 (i.e., <80% expansion).Results: The VBX was the only bSG that could be expanded to its intended diameter (i.e., at least 80%) at nominal pressure. The BeGraft Peripheral and BeGraft Plus had the lowest degree of expansion after nominal and rated burst pressure. All bSGs that were tested reached a sufficient expansion degree after using a higher pressure balloon.Conclusion: In this ex vivo experiment, dilation up to nominal pressure showed satisfactory expansion only for the VBX. The consistency of the results when applied to the different types of stent grafts that were analysed reflects structural stent graft specific issues to consider when choosing the right device in cases of ISLF.
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| 27. |
- Markstad, Hanna, et al.
(författare)
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High Levels of Soluble Lectinlike Oxidized Low-Density Lipoprotein Receptor-1 Are Associated With Carotid Plaque Inflammation and Increased Risk of Ischemic Stroke
- 2019
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Ingår i: Journal of the American Heart Association. - 2047-9980. ; 8:4
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Tidskriftsartikel (refereegranskat)abstract
- Background When the lectinlike oxidized low-density lipoprotein (ox LDL) receptor-1 ( LOX -1), a scavenger receptor for ox LDL , binds ox LDL , processes leading to endothelial dysfunction and inflammation are promoted. We aimed to study release mechanisms of LOX -1 and how circulating levels of soluble LOX -1 ( sLOX -1) relate to plaque inflammation and future risk for ischemic stroke. Methods and Results Endothelial cells and leukocytes were used to study release of sLOX -1. Plasma levels of sLOX -1 were determined in 4703 participants in the Malmö Diet and Cancer cohort. Incidence of ischemic stroke was monitored. For 202 patients undergoing carotid endarterectomy, levels of sLOX -1 were analyzed in plasma and plaque homogenates and related to plaque inflammation factors. Endothelial cells released sLOX -1 when exposed to ox LDL . A total of 257 subjects experienced stroke during a mean follow-up of 16.5 years. Subjects in the highest tertile of sLOX -1 had a stroke hazard ratio of 1.75 (95% CI, 1.28-2.39) compared with those in the lowest tertile after adjusting for age and sex. The patients undergoing carotid endarterectomy had a significant association between plasma sLOX -1 and the plaque content of sLOX -1 ( r=0.209, P=0.004). Plaques with high levels of sLOX -1 had more ox LDL , proinflammatory cytokines, and matrix metalloproteinases. Conclusions Our findings demonstrate that ox LDL induces the release of sLOX -1 from endothelial cells and that circulating levels of sLOX -1 correlate with carotid plaque inflammation and risk for ischemic stroke. These observations provide clinical support to experimental studies implicating LOX -1 in atherosclerosis and its possible role as target for cardiovascular intervention.
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| 28. |
- Racyte, Austeja, et al.
(författare)
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Left subclavian artery bridging stent fracture after in-situ laser fenestration during emergent thoracic endovascular aortic repair
- 2024
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Ingår i: Journal of Vascular Surgery Cases and Innovative Techniques. - : Elsevier. - 2468-4287. ; 10:5
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Tidskriftsartikel (refereegranskat)abstract
- In-situ laser fenestration (ISLF) has been described as a viable option for urgent thoracic aortic aneurysm cases involving supra-aortic vessels. There are, however, limited data on its durability. Here, we present a case of a 70-year-old man with a symptomatic 13-cm thoracic aortic aneurysm extending proximally to the origin of the left subclavian artery (LSA). Emergent thoracic endovascular aortic repair with chimney stenting of the left common carotid artery and ISLF for the LSA was successfully performed. During the follow-up, a compression of the bridging stent to the LSA progressed to a stent fracture needing realignment. Despite ISLF's reported technical success, this case highlights the risk of bridging stent complications, emphasizing the need for a close follow-up. (J Vasc Surg Cases Innov Tech 2024;10:101550.)
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| 29. |
- Shami, Annelie, et al.
(författare)
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Expression of fibromodulin in carotid atherosclerotic plaques is associated with diabetes and cerebrovascular events.
- 2015
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Ingår i: Atherosclerosis. - : Elsevier BV. - 1879-1484 .- 0021-9150. ; 241:2, s. 701-708
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Tidskriftsartikel (refereegranskat)abstract
- The small leucine-rich proteoglycans fibromodulin and lumican are functionally related extracellular matrix proteins involved in the regulation of collagen fiber formation. Fibromodulin-deficient apolipoprotein E-null mice have decreased vascular retention of lipids and reduced development of atherosclerosis suggesting that fibromodulin may influence the disease process. The aim of the present study was to investigate if fibromodulin and lumican are expressed in human carotid plaques and to determine if their expression is associated with the occurrence of preoperative symptoms and with risk for postoperative cardiovascular events.
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| 30. |
- Svensson-Björk, Robert, et al.
(författare)
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Cost-effectiveness analysis of negative pressure wound therapy dressings after open inguinal vascular surgery - The randomised INVIPS-Trial
- 2021
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Ingår i: Journal of Tissue Viability. - : Elsevier BV. - 0965-206X. ; 30:1, s. 95-101
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Tidskriftsartikel (refereegranskat)abstract
- AIM: While the scientific evidence in favour of negative pressure wound therapy (NPWT) dressings on sutured incisions in the prevention of surgical site infections (SSIs) has increased, the cost-effectiveness after vascular surgery has not been evaluated. The aim of this study was to evaluate the cost-effectiveness of NPWT compared to standard dressings for the prevention of SSIs after open inguinal vascular surgery.MATERIALS AND METHODS: Patient data were retrieved from the randomised INVIPS-trial's open arm, which included patients randomised to either NPWT or standard dressings. The patients were surveyed for SSIs for 90 days postoperatively. The patients' individual cost data were included and analysed from a healthcare perspective. The patients' quality of life was measured using the Vascuqol-6 questionnaire pre- and 30 days postoperatively. Cost-effectiveness of NPWT was determined by decreased or equal total costs and a significant reduction in SSI incidence.RESULTS: The mean vascular procedure-related costs at 90 days were €16,621 for patients treated with NPWT (n = 59) and €16,285 for patients treated with standard dressings (n = 60), p = 0.85. The SSI incidence in patients treated with NPWT was 11.9% (n = 7/59) compared to 30.0% (n = 18/60) with standard dressings, p = 0.015. This corresponds to an increased mean cost of €1,853 per SSI avoided. The cost-effectiveness plane of incremental vascular procedure-related costs and difference in Vascuqol-6 score showed that 42% of estimates were in the quadrant where NPWT was dominant.CONCLUSION: NPWT is considered cost-effective over standard dressings in patients undergoing open inguinal vascular surgery due to reduced SSI incidence at no higher costs.
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| 31. |
- Svensson Björk, Robert, et al.
(författare)
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Negative Pressure Wound Therapy for the Prevention of Surgical Site Infections Using Fascia Closure After EVAR-A Randomized Trial
- 2022
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Ingår i: World Journal of Surgery. - : Springer. - 0364-2313 .- 1432-2323. ; 46:12, s. 3111-3120
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Tidskriftsartikel (refereegranskat)abstract
- Background Surgical site infections (SSI) in the groin after vascular surgery are common. The aim of the study was to evaluate the effect of negative pressure wound therapy (NPWT) on SSI incidence when applied on closed inguinal incisions after endovascular aneurysm repair (EVAR). Methods A multicenter randomized controlled trial (RCT). Between November 2013 and December 2020, 377 incisions (336 bilateral and 41 unilateral) from elective EVAR procedures with the primary intent of fascia closure were randomized and included, receiving either NPWT or a standard dressing. In bilateral incisions, each incision randomly received the opposite dressing of the other side, thereby becoming each others control. The primary endpoint was SSI incidence at 90 days postoperatively, analyzed on an intention-to-treat basis. Uni and bilaterally operated incisions were analyzed separately, and their respective p-values combined using Fishers method for combining P-values. Study protocol (NCT01913132). Results The SSI incidence at 90 days postoperatively in bilateral incisions was 1.8% (n = 3/168) in the NPWT and 4.8% (n = 8/168) in the standard dressing group, and in unilateral incisions 13.3% (n = 2/15) and 11.5% (n = 3/26), respectively (combined p = 0.49). In all SSIs, bacteria were isolated from incisional wound cultures. No additional SSIs were diagnosed between 90 days and 1 year follow-up. Conclusions No evidence of difference in SSI incidence was seen in these low-risk inguinal incisions when comparing NPWT with standard dressings after EVAR with the primary intent of fascia closure.
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| 32. |
- Usai, Marco, V, et al.
(författare)
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Systematic review of atherectomy of inguinal arteries for atherosclerotic lesions
- 2022
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Ingår i: Journal of Cardiovascular Surgery. - : Edizioni Minerva Medica. - 0021-9509 .- 1827-191X. ; 63:1, s. 2-7
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Forskningsöversikt (refereegranskat)abstract
- INTRODUCTION: Surgical endarterectomy represents the gold standard for the treatment of atherosclerotic lesions of the groin vessels. Endovascular treatment such as atherectomy with or without drug coated angioplasty (DCA) of the so called no stenting zones, i.e. inguinal and popliteal vessels, is gaining growing acceptance as alternative option to open surgery. This systematic review aims to scrutiny the current clinical evidence regarding atherectomy and DCA for the common artery (CFA).EVIDENCE ACQUISITION: We conducted an exhaustive research in multiple platforms (Medline, PubMed, Cochrane, Google Scholar, Em base) on studies over atherectomy and angioplasty for inguinal atherosclerotic lesions published between 2000 and 2021. As search strategy we used a wide list of MeSH items, words, synonyms. Bibliographies of review articles were checked for further relating studies regarding atherectomy of CFA. A qualitative and quantitative data analysis was carried out.EVIDENCE SYNTHESIS: Fifteen studies were included in the qualitative review. Not all studies were focused only on atherectomy of inguinal vessels, despite including such treatment. Hence, data regarding this treatment were not exhaustive. A fairly homogeneous data analysis was possible in 7 of 15 studies. The remaining 8 studies were qualitatively analyzed but not included in the statistical analysis. In all 7 included studies directional atherectomy and DCA under filter protection were carried out. In this subgroup, overall, 497 patients were treated with atherectomy. Sixty-eight percent of the patients were males. Rutherford class from 1-3 dominated against 4-6 (63% vs. 37%). Mean technical success rate was 96%, with a primary and secondary patency rate of 92% and 98% respectively at one year. Procedure related vascular complications ranged from 1% to 6%.CONCLUSIONS: Current literature about atherectomy for inguinal arteries is scant, data are inhomogeneous and so are treatment modalities. Nevertheless, the results of this systematic review suggest that this endovascular strategy is feasible with good short and midterm results. Prospective trials with larger patient cohorts are necessary to confirm these preliminary results.
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| 33. |
- Yu, Hok Yee Harry, et al.
(författare)
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An updated systematic review and meta-analysis of pre-emptive aortic side branch embolization to prevent type II endoleaks after endovascular aneurysm repair
- 2023
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Ingår i: Journal of Vascular Surgery. - : Elsevier BV. - 0741-5214 .- 1097-6809. ; 77:6, s. 1815-1821
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Tidskriftsartikel (refereegranskat)abstract
- Objective: Pre-emptive embolization of aortic side branches may be effective in preventing type II endoleaks (T2EL) based on a previous systematic review and meta-analysis by our group. Data up to 2019 was, however, only based on retrospective studies. The aim of the current study was to update the meta-analysis and evaluate the current evidence on this treatment strategy.Methods: A systematic literature search was performed with the same keywords and strategies used in the previous study. The complementary search included all articles published from January 1, 2019, through May 29, 2022. The incidence of aneurysm sac growth was the primary outcome of interest.Results: Four new studies were identified, including one randomized controlled study and one nationwide registry-based retrospective study. Overall, the incidence of sac size enlargement was 4.3% in the embolization group compared with 6.8% in the control group (odds ratio [OR], 0.38; 95% confidence interval [CI], 0.26-0.55), the incidence of T2EL was 19.7% vs 37.4% (OR, 0.38; 95% CI, 0.30-0.47), and the incidence of reintervention for T2EL was 1.2% vs 11.2% (OR, 0.12; 95% CI, 0.06-0.23).Conclusions: Current evidence confirms lower incidence of aneurysm sac growth, T2EL, and reinterventions when preemptive embolization of aortic side branches is performed in conjunction with endovascular aneurysm repair, compared with no embolization. However, a higher level of evidence is still required to support a broad change of practice, including data on cost-effectiveness and on the potential effect on rupture.
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