| 1. |
- Butt, Talha, et al.
(författare)
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Amputation-Free Survival in Patients With Diabetes Mellitus and Peripheral Arterial Disease With Heel Ulcer : Open Versus Endovascular Surgery
- 2019
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Ingår i: Vascular and Endovascular Surgery. - : SAGE Publications. - 1938-9116 .- 1538-5744. ; 53:2, s. 118-125
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND:: Heel ulcers in patients with diabetes mellitus (DM) and peripheral arterial disease (PAD) are hard to heal. The aim of the present study was to evaluate the difference in amputation-free survival (AFS) between open and endovascular revascularization in patients with DM, PAD, and heel ulcers.METHODS:: Retrospective comparative study of results of open versus endovascular surgery in patients with DM, PAD, and heel ulcer presented at the multidisciplinary diabetes foot clinic between 1983 and 2013.RESULTS:: Patients with heel ulcers were treated with endovascular intervention (n = 97) and open vascular surgery (n = 30). Kaplan-Meier analysis showed that the AFS was higher in patients undergoing open vascular surgery compared to the endovascular group ( P = .009). Multivariate analysis showed that open vascular surgery versus endovascular therapy (hazard ratio 2.1, 95% confidence interval 1.1-3.9; P = .025) was an independent factor associated with higher AFS. The proportion of patients undergoing endovascular therapy in the former (1983-2000) time period was 47% compared to 89% in the latter (2001-2013) time period ( P < .001).CONCLUSION:: The AFS was higher after open than endovascular surgery among patients with DM and PAD with heel ulcer. These results suggest that open vascular surgery should be offered more often as opposed to current practice.
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| 2. |
- Butt, Talha, et al.
(författare)
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Amputation-free survival in patients with diabetic foot ulcer and peripheral arterial disease : Endovascular versus open surgery in a propensity score adjusted analysis
- 2020
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Ingår i: Journal of Diabetes and its Complications. - : Elsevier BV. - 1056-8727. ; 34:5
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Tidskriftsartikel (refereegranskat)abstract
- Aims: The aim of the present study was to compare outcomes of endovascular surgery versus open vascular surgery in patients with diabetic foot ulcer (DFU) and peripheral arterial disease (PAD). Methods: Between 1984 and 2006, 1151 patients with DFU were admitted to the diabetic foot care team. Three hundred seventy-six patients with 408 limbs were consecutively included at a multidisciplinary foot center, 289 limbs were treated with endovascular surgery and 119 limbs with open vascular surgery first strategy. A propensity score adjusted analysis was performed to compare outcomes for type of revascularization. Results: Major amputation rates at 3 years were 17.0% and 16.8% (p = 0.97) and mortality at 3 years were 43.1% and 46.5% (p = 0.55) after endovascular surgery and open vascular surgery, respectively. In the propensity score adjusted analysis, patients undergoing endovascular surgery first had similar outcomes in terms of major amputation, mortality, combined major amputation/mortality compared to those undergoing open vascular surgery. Longer time to intervention (p = 0.003) was associated with increased major amputation rate in the multivariable Cox regression analysis. Conclusion: The endovascular surgery first and open vascular surgery first strategies were associated with similar long-term results in a large cohort of patients with DFU and PAD undergoing revascularization. Rapid revascularization reduces the risk of amputation.
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| 3. |
- Lilja, Erika, et al.
(författare)
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Diabetes mellitus was not associated with lower amputation-free survival after open revascularization for chronic limb-threatening ischemia : A nationwide propensity score adjusted analysis
- 2021
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Ingår i: Vascular Medicine. - 1477-0377. ; 26:5, s. 507-514
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Tidskriftsartikel (refereegranskat)abstract
- The risk of major amputation is higher after urgently planned endovascular therapy for chronic limb-threatening ischemia (CLTI) in patients with diabetes mellitus (DM). The aim of this nationwide cohort study was to compare outcomes between patients with and without DM following urgently planned open revascularization for CLTI from 2010 to 2014. Out of 1537 individuals registered in the Swedish Vascular Registry, 569 were registered in the National Diabetes Register. A propensity score adjusted Cox regression analysis was conducted to compare outcome between the groups with and without DM. Median follow-up was 4.3 years and 4.5 years for patients with and without DM, respectively. Patients with DM more often had foot ulcers (p = 0.034) and had undergone more previous amputations (p = 0.001) at baseline. No differences in mortality, cardiovascular death, major adverse cardiovascular events (MACE), or major amputation were observed between groups. The incidence rate of stroke was 70% higher (95% CI: 1.11-2.59; p = 0.0137) and the incidence rate of acute myocardial infarction (AMI) 39% higher (95% CI: 1.00-1.92; p = 0.0472) among patients with DM in comparison to those without. Open vascular surgery remains a first-line option for a substantial number of patients with CLTI, especially for limb salvage in patients with DM. The higher incidence rates of stroke and AMI among patients with DM following open vascular surgery for infrainguinal CLTI require specific consideration preoperatively with the aim of optimizing medical treatment to improve cardiovascular outcome postoperatively.
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| 4. |
- Lilja, Erika
(författare)
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Surgical aspects on patients with diabetes mellitus and chronic limb-threatening ischemia
- 2022
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: During the 21st century, diabetes mellitus (DM) and peripheral artery disease (PAD) have become global problems. It is estimated that 19-34% of individuals with DM will develop a foot ulcer during their lifetime, and many will be amputated.Aim:-To study dietary and lifestyle factors associated with prevention of PAD among individuals with DM. -To evaluate outcomes after vascular and endovascular treatment in patients with DM and chronic limb- threatening ischemia (CLTI).Methods: Paper I, based on the Malmö Diet and Cancer study focuses on patients with prevalent DM. Papers II and III are based on the Swedish Vascular Register and the Swedish National Diabetes Register. A propensity score adjusted Cox regression analysis was conducted to compare outcomes following endovascular therapy and open vascular surgery, respectively, between patients with and without DM. Paper IV compares outcome following open and endovascular surgery for patients with DM, PAD, and heel ulcers presenting at the multidisciplinary diabetes foot clinic.Results: A higher intake of fish and shellfish tended to confer a protective effect against the development of PAD among individuals with DM (HR per additional gram per week 0.99, 95% CI 0.99-1.00, p=0.051). Incidence rates (IR) of major amputation and acute myocardial infarction (AMI) were 43% (95% CI 1.23-1-67) and 37% (95% CI 1.13-1.67) higher, respectively, among patients with DM compared to patients without DM following endovascular therapy for CLTI. IR of major amputation or death was 13% higher (95% CI 1.04-1.23; p=0.004) higher among patients with DM after endovascular therapy for CLTI.IR of stroke and AMI were 70% (95% CI 1.11-2.59) and 39% (95% CI 1.00-1.92) higher, among patients with DM compared to patients without DM following open vascular surgery, whereas there was no difference in major amputation (HR 1.28, 95% CI 0.98-1.66; p=0.070) or the compound variable major amputation or death (HR 1.15, 95% CI 0.98-1.35; p=0.090) following open vascular surgery.Open vascular surgery was associated with higher amputation-free survival (AFS, HR 2.1, 95% CI 1.1-3.9) compared to endovascular therapy among patients with DM, PAD, and heel ulcers.Conclusions: A higher intake of fish and shellfish tended to confer a protective effect against the development of PAD among individuals with DM. In contrast to patients undergoing endovascular therapy, there was no difference in major amputation or death after open vascular surgery between those with and without DM. Amputation-free survival (AFS) was higher after open than endovascular surgery among patients with DM and PAD with heel ulcers. Open vascular surgery remains a first-line option for a substantial part of patients with CLTI, especially for limb salvage in patients with DM. These results suggest that open vascular surgery should be offered more often as opposed to current practice.
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| 5. |
- Lilja, Erika, et al.
(författare)
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The association between dietary intake, lifestyle and incident symptomatic peripheral arterial disease among individuals with diabetes mellitus : insights from the Malmö Diet and Cancer study
- 2019
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Ingår i: Therapeutic Advances in Endocrinology and Metabolism. - : SAGE Publications. - 2042-0188 .- 2042-0196. ; 10, s. 1-8
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Tidskriftsartikel (refereegranskat)abstract
- With the rising prevalence of both diabetes mellitus (DM) and peripheral arterial disease (PAD), the aim of this project was to examine the association between dietary intake and lifestyle on the risk of developing PAD among individuals with DM. The Malmö Diet and Cancer study was a prospective cohort study with baseline examinations carried out between 1991 and 1996 in Malmö, Sweden (n = 30,446). Individuals with prevalent PAD and cardiovascular disease (prior stroke or myocardial infarction) were excluded from the study, resulting in a total study population of 1112 patients with prevalent DM. The diagnosis of incident PAD was validated and confirmed in 98% of patients. Of the 1112 individuals, 136 (12.2%) were diagnosed with PAD during a median follow up of 19.7 years (interquartile range 12.9–22.4). Kaplan–Meier analysis showed that men with DM more often developed incident PAD compared with women (cumulative incidences 15.5% and 8.9%, respectively, p = 0.012). In Cox multivariable regression analysis, smoking (hazard ratio of 1.96, 95% confidence interval of 1.28–3.00) was associated with increased risk of PAD, and there was a trend that a higher intake of fish and shellfish (hazard ratio per additional gram per week of 0.99, 95% confidence interval of 0.99–1.00; p = 0.051) was associated with a decreased risk of PAD. In conclusion, the present study demonstrated a trend towards a protective effect of higher intake of fish and shellfish upon incident symptomatic PAD among individuals with DM.
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| 6. |
- Lilja, Erika, et al.
(författare)
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The impact of diabetes mellitus on major amputation among patients with chronic limb threatening ischemia undergoing elective endovascular therapy- a nationwide propensity score adjusted analysis.
- 2021
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Ingår i: Journal of diabetes and its complications. - : Elsevier BV. - 1873-460X .- 1056-8727. ; 35:2
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Tidskriftsartikel (refereegranskat)abstract
- To investigate the risk of major amputation after elective endovascular therapy in patients with chronic limb threatening ischemia (CLTI) comparing patients with and without diabetes mellitus (DM).In this nationwide cohort study, all patients registered in the Swedish Vascular Register after elective endovascular therapy for CLTI caused by infra-inguinal arterial disease from 2010 to 2014 were included. Among 4578 individuals, 2251 had DM and were registered in the National Diabetes Register between 2009 and 2014. A propensity score adjusted Cox regression analysis was conducted to compare outcomes between groups. Median follow-up was 4.0 and 3.6years for patients with DM and without DM, respectively.The incidence rates of major amputation and acute myocardial infarction (AMI) were 43% (95% CI 1.23-1.67) and 37% (95% CI 1.13-1.67) higher, respectively, among patients with DM compared to patients without DM. There was no difference in mortality (HR 1.04, 95% CI 0.95-1.14).Patients with DM had a higher risk of major amputation and AMI compared to those without DM after elective endovascular therapy for CLTI. Prevention of DM with CLTI is of utmost importance to reduce the risk of adverse limb and cardiovascular outcomes.
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| 7. |
- Lilja, Karl, et al.
(författare)
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Screening study on occurrence of hazardous substances in the eastern Baltic Sea
- 2009
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Rapport (övrigt vetenskapligt/konstnärligt)abstract
- IVL and NILU have during 2008/2009 as an assignment from HELCOM, performed a screening study in the eastern Baltic Sea environment on the occurrence of eight of the substances/substance groups identified as hazardous under the Baltic Sea Action Plan. Of the eight substances or substance classes included in the study, six of them were found above LOQ; organic tin compounds, PBDEs, PFAS, nonylphenol, chlorinated paraffins and endosulfan (endosulfan sulphate). Substances that occurred in fish samples from all sampling sites were; TBT, PBDEs (BDE 47 and BDE 100), PFAS (PFOS), chlorinated paraffins (SCCP), and endosulfan (endosulfan sulphate). Additionally, bisphenol A was found in fish from almost all sampling sites. PFAS (PFOS and PFOA), octyphenol and nonylphenol were found in one, one and six water samples, respectively. No obvious differences in concentrations could be seen between the sampling sites classified as background areas and affected areas. Furthermore, no clear general differences between affected sites could be seen. Concentrations found for the different substances were lower or in the same range as previously reported from other areas of the Baltic Sea, thus the eastern Baltic Sea environment does not seem to be more polluted compared to the Baltic Sea in general. For all the substances, except TBT, concentrations found were below reported PNEC values. However, for TBT, concentrations in several fish muscle samples were close to or above the PNEC value estimated for protection of human health considering consumption of fishery products. Additionally, PFOS levels in fish liver exceeded the PNEC value regarding secondary poisoning of predators in six samples, but PFOS levels in fish muscle were not measured in this study.
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