SwePub
Sök i SwePub databas

  Utökad sökning

Träfflista för sökning "WFRF:(Resch Timothy) "

Sökning: WFRF:(Resch Timothy)

  • Resultat 1-50 av 53
Sortera/gruppera träfflistan
   
NumreringReferensOmslagsbildHitta
1.
  • Resch, Timothy A., et al. (författare)
  • Remodeling of the thoracic aorta after stent grafting of type B dissection : a Swedish multicenter study
  • 2006
  • Ingår i: Journal of Cardiovascular Surgery. - 0021-9509 .- 1827-191X. ; 47:5, s. 503-508
  • Tidskriftsartikel (refereegranskat)abstract
    • AIM: Endovascular repair of complicated type B dissections has evolved as a promising alternative to open repair. Previous studies have indicated that continued false lumen flow is a predictor of continued aortic dilatation and risk of rupture during follow-up. This multicenter study was conducted to analyze the postoperative changes of the false lumen after endografting of complicated type B dissections. METHODS: All patients treated with endovascular stent grafts for thoracic type B dissections at 5 major Vascular Centers in Sweden were identified through local databases. Review of charts and all available pre- and postoperative CT scans were performed to identify demographics, indications for repair as well as postoperative changes of the aorta and false lumen. RESULTS: A total of 129 patients treated for type B dissections between 1994 and December 2005 were identified. Median radiological follow-up was 14 months. Fourteen patients died perioperatively leaving 115 patients available for analysis. Seventy-four of these had CT imaging of sufficient quality for morphological analysis. The vast majority of acute patients were treated for rupture or end-organ ischemia whereas most chronic patients were treated for asymptomatic aneurysms. In 80% of patients, the false lumen thrombosed along the stent graft but it remained perfused distal to the stent graft fixation in 50% of patients. Only 5% of patients presented with aortic enlargement of the stent grafted area when adequate proximal sealing was achieved. The distal, uncovered aorta displayed expansion in 16% of patients. CONCLUSIONS: The stent grafted thoracic aorta after type B dissection appears to be stabilized by covering the primary entry site with a stent graft in the majority of both acute and chronic dissections. The uncovered portion of the aorta distal to the stent graft, however, remains at risk of continuous dilatation. Stent grafting for complicated type B thoracic dissections seems to be a treatment option with reasonable morbidity and mortality even though the incidence of severe complications is still significant.
  •  
2.
  • Acosta, Stefan, et al. (författare)
  • Diagnostic pitfalls at admission in patients with acute superior mesenteric artery occlusion
  • 2012
  • Ingår i: Journal of Emergency Medicine. - : Elsevier. - 0736-4679 .- 1090-1280. ; 42:6, s. 635-641
  • Tidskriftsartikel (refereegranskat)abstract
    • BACKGROUND: Acute superior mesenteric artery (SMA) occlusion leads to acute intestinal ischemia and is associated with high mortality. Early diagnosis is often missed, and confounding factors leading to diagnostic delays need to be highlighted.OBJECTIVES: To identify potential diagnostic laboratory pitfalls at admission in patients with acute SMA occlusion.METHODS: Fifty-five patients with acute SMA occlusion were identified from the in-hospital register during a 4-year period, 2005-2009.RESULTS: The median age was 76 years; 78% were women. The occlusion was embolic in 53% and thrombotic in 47% of patients. At admission, troponin I was above the clinical decision level (> 0.06 μg/L) for acute ischemic myocardial injury in 9/19 (47%) patients with embolic occlusion. Elevated pancreas amylase and normal plasma lactate were found in 12/45 and 13/27, respectively. A troponin I (TnI) above the clinical decision level was associated with a high frequency of referrals from the general surgeon to a specialist in internal medicine (p = 0.011) or a cardiologist (p = 0.024). The diagnosis was established after computed tomography angiography in 98% of the patients. The overall in-hospital mortality rate was 33%. Attempting intestinal revascularization (n = 43; p < 0.001), with a 95% frequency rate of completion control of the vascular procedure, was associated with a higher survival rate, whereas referral to the cardiologist was associated with a higher mortality rate (p = 0.018).CONCLUSION: Elevated TnI was common in acute SMA occlusion, and referral to the cardiologist was found to be associated with adverse outcome. Elevated pancreas amylase and normal plasma lactate values are also potential pitfalls at admission in patients with acute SMA occlusion.
  •  
3.
  • Antoniou, George A., et al. (författare)
  • European society for vascular surgery clinical practice guideline development scheme : an overview of evidence quality assessment methods, evidence to decision frameworks, and reporting standards in guideline development
  • 2022
  • Ingår i: European Journal of Vascular and Endovascular Surgery. - : Elsevier. - 1078-5884 .- 1532-2165. ; 63:6, s. 791-799
  • Forskningsöversikt (refereegranskat)abstract
    • Objective: A structured and transparent approach is instrumental in translating research evidence to health recommendations and evidence informed clinical decisions. The aim was to conduct an overview and analysis of principles and methodologies for health guideline development.Methods: A literature review on methodologies, strategies, and fundamental steps in the process of guideline development was performed. The clinical practice guideline development process and methodology adopted by the European Society for Vascular Surgery are also presented.Results: Sophisticated methodologies for health guideline development are being applied increasingly by national and international organisations. Their overarching principle is a systematic, structured, transparent, and iterative process that is aimed at making well informed healthcare choices. Critical steps in guideline development include the assessment of the certainty of the body of evidence; evidence to decision frameworks; and guideline reporting. The goal of strength of evidence assessments is to provide well reasoned judgements about the guideline developers’ confidence in study findings, and several evidence hierarchy schemes and evidence rating systems have been described for this purpose. Evidence to decision frameworks help guideline developers and users conceptualise and interpret the construct of the quality of the body of evidence. The most widely used evidence to decision frameworks are those developed by the GRADE Working Group and the WHO-INTEGRATE, and are structured into three distinct components: background; assessment; and conclusions. Health guideline reporting tools are employed to ensure methodological rigour and transparency in guideline development. Such reporting instruments include the AGREE II and RIGHT, with the former being used for guideline development and appraisal, as well as reporting.Conclusion: This guide will help guideline developers/expert panels enhance their methodology, and patients/clinicians/policymakers interpret guideline recommendations and put them in context. This document may be a useful methodological summary for health guideline development by other societies and organisations.
  •  
4.
  • Asciutto, Giuseppe, et al. (författare)
  • Grafts Outside the United States
  • 2021
  • Ingår i: Complications in Endovascular Surgery : Peri-Procedural Prevention and Treatment - Peri-Procedural Prevention and Treatment. - 9780323554497 - 9780323554480 ; , s. 83-85
  • 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.
  •  
5.
  • Björnsson, Steinarr, et al. (författare)
  • Symptomatic Mesenteric Atherosclerotic Disease-Lessons Learned from the Diagnostic Workup.
  • 2013
  • Ingår i: Journal of Gastrointestinal Surgery. - : Springer Science and Business Media LLC. - 1873-4626 .- 1091-255X. ; 17:5, s. 973-980
  • Tidskriftsartikel (refereegranskat)abstract
    • OBJECTIVE: This study aims to analyze the diagnostic workup in patients referred for endovascular mesenteric revascularization for symptomatic mesenteric atherosclerotic disease. MATERIAL AND METHODS: Fifty-five patients were identified between 2006 and 2011. Median follow-up time was 24 months. RESULTS: Median age was 71 years, 67 % were women. Forty patients had acute on chronic mesenteric ischemia, eight had acute mesenteric ischemia, and seven had chronic mesenteric ischemia. Other manifestations of atherosclerotic disease were present in 71 %. Body mass index (BMI) <20 kg/m(2) was found in 37 %. Endoscopy diagnosed duodenitis (38 %; 13/34) and colitis in the right colon (57 %;12/21). All ulcers tested for Helicobacter pylori were negative (n = 17). Patients received proton pump inhibitor, antibiotic, and cortisone therapy during diagnostic workup in 73, 42, and 29 % of the cases, respectively. Previous hospitalization for the same complaints had occurred in 78 %. CT angiography showed occlusion (n = 30) and high-grade stenosis (n = 25) of the superior mesenteric artery (SMA). Forty-eight patients were treated with stenting of the SMA. The BMI increased in both women (p = 0.001) and men (p = 0.03) after endovascular therapy. The in-hospital mortality rate was 18 %. CONCLUSION: Patients with abdominal pain, known atherosclerotic disease, right-sided colitis or H. pylori-negative duodenitis should undergo CT angiography immediately to be able to identify symptomatic mesenteric atherosclerotic disease.
  •  
6.
  • Björnsson, Steinarr, et al. (författare)
  • Thrombolysis for acute occlusion of the superior mesenteric artery
  • 2011
  • Ingår i: Journal of Vascular Surgery. - : Elsevier BV. - 0741-5214 .- 1097-6809. ; 54:6, s. 1734-1742
  • Tidskriftsartikel (refereegranskat)abstract
    • BACKGROUND: This study evaluated the incidence, complications, and outcome of local intra-arterial thrombolytic therapy for acute superior mesenteric artery (SMA) occlusion in Sweden. METHODS: Patients undergoing local intra-arterial thrombolytic therapy for acute SMA occlusion were identified in the Swedish Vascular Registry (SWEDVASC) between 1987 and 2009. Patient data were retrieved in a structured protocol by local vascular surgeons at each participating hospital. RESULTS: Included were 34 patients (20 women) from 12 hospitals. Median age was 78 years. The first patient was treated in 1997, and the annual number of patients undergoing thrombolysis increased continuously from 2004 to 2009. Twenty-eight patients (82%) had embolic occlusion. No patients (0%) had acute peritonitis, and one (3%) had bloody stools at admission. Thirty-two patients (94%) were diagnosed by computed tomography with intravenous contrast enhancement. The median dose of alteplase was 20 mg (interquartile range, 11.6-34.0). Successful thrombolysis was achieved in 30 patients (88%). Initial adjunctive aspiration thromboembolectomy was performed in 10 patients. There were six self-limiting bleeding complications; one from the gastrointestinal tract. Thirteen explorative laparotomies, 10 repeat laparotomies, and eight bowel resections were performed. The in-hospital mortality rate was 26% (9 of 34). Age was not associated with in-hospital death (P = .42). Successful thrombolysis was associated with decreased mortality (P = .048). CONCLUSION: Local thrombolysis for acute SMA occlusion is a minimally invasive and effective treatment alternative in a select group of patients without peritonitis. The few technique-related complications were mild.
  •  
7.
  • Borring, Margareta, et al. (författare)
  • Akut buksmärta under pågående graviditet var spontan ruptur av a uterina. Ovanligt och livshotande tillstånd
  • 2010
  • Ingår i: Läkartidningen. - 0023-7205. ; 107:41, s. 2484-2486
  • Tidskriftsartikel (refereegranskat)abstract
    • This case report illustrates a very rare and very serious complication during ongoing pregnancy, namely spontaneous rupture of the uterine artery. Late diagnosis increases the morbidity and mortality for the foetus as well as for the pregnant woman. Angiography gives the diagnosis. In the differential diagnosis of acute abdomen in a pregnant woman spontaneous rupture of the uterine arteries as the cause of intra abdominal bleeding during the second and third trimester should be included, especially with a history of endometriosis.
  •  
8.
  • Chisci, Emiliano, et al. (författare)
  • The AAA With a Challenging Neck: Outcome of Open Versus Endovascular Repair With Standard and Fenestrated Stent-Grafts
  • 2009
  • Ingår i: Journal of Endovascular Therapy. - : International Society of Endovascular Specialists. - 1545-1550 .- 1526-6028. ; 16:2, s. 137-146
  • Tidskriftsartikel (refereegranskat)abstract
    • Purpose: To compare the outcome of endovascular aneurysm repair (EVAR) versus conventional open repair (OR) in patients with a short, angulated or otherwise challenging proximal neck. Methods: The definition of a challenging proximal neck was based on diameter (>= 28 mm), length (<= 115 mm), angulation (>= 60 degrees), shape (reverse tapered or bulging), and thrombus lining (>50%). Between January 2005 and December 2007, 187 consecutive patients (159 men; mean age 73 years, range 48-92) operated for asymptomatic abdominal aortic aneurysm (AAA) were identified as having challenging proximal neck morphology. Of these, 61 patients were treated with OR at center I (group A), 71 with standard EVAR (group B; 45 center I, 29 center II) and 52 with fenestrated EVAR (group C) at center II. Clinical examination and computed tomography were performed at 1 month and yearly thereafter. Results: There was no statistically significant difference between groups A, B, and C regarding primary technical success rate, 30-day mortality, or late AAA-related mortality. The mean length of follow-up was 19.5 months (range 0-40). Freedom from reintervention at 3 years was 91.8%, 79.7%, and 82.7% for groups A, B, and C, respectively (p=0.042). The only statistically significant difference between standard and fenestrated EVAR was a higher incidence of late sac expansion [9 (12.2%) versus 1 (1.9%), p=0.036] in the standard stent-graft group. Reinterventions were more frequent after EVAR (p=NS), but open reinterventions were more common after OR. Reinterventions after EVAR were related to the presence of an angulated (p=0.039) or short neck (p=0.024). Conclusion:The results of EVAR and OR were similar for AAAs with a challenging proximal neck. Endovascular reinterventions were more frequent after EVAR, particularly in patients with an angulated or short neck. Open reinterventions were more common after OR. More patients and long-term data are needed to confirm these findings. J Endovasc Ther. 2009;16:137-146
  •  
9.
  • Chuter, Timothy A M, et al. (författare)
  • Aneurysm pressure following endovascular exclusion
  • 1997
  • Ingår i: European Journal of Vascular and Endovascular Surgery. - 1532-2165. ; 13:1, s. 85-87
  • Tidskriftsartikel (refereegranskat)abstract
    • OBJECTIVES: To assess the effect of stent-graft implantation on the pressure within an abdominal aortic aneurysm. METHODS: Aneurysm exclusion was performed using an aorto-uniiliac stent-graft in eight patients. Following stent-graft implantation, pressure measurements were performed through a catheter adjacent to the graft in the aneurysm. This "aneurysm pressure" was compared with radial arterial pressure. RESULTS: The pressure was lower in the aneurysm than in the radial artery, in all cases. Mean aneurysm pressure was 36.5/33.8 mmHg, while mean radial arterial pressure was 118.5/50.5 mmHg (p < 0.05, for both systolic and diastolic pressures). These findings corresponded with a reduction in the palpable abdominal pulse, and an absence of perigraft perfusion on follow-up computerised tomography. CONCLUSION: Stent-graft implantation produces a fall in the pressure within an abdominal aortic aneurysm.
  •  
10.
  •  
11.
  • Dias, Nuno, et al. (författare)
  • Reply.
  • 2008
  • Ingår i: Journal of Vascular Surgery. - : Elsevier BV. - 1097-6809 .- 0741-5214. ; 47:4, s. 899-900
  • Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)
  •  
12.
  • Edsfeldt, Andreas, et al. (författare)
  • Validation of a New Method for 2D Fusion Imaging Registration in a System Prepared Only for 3D
  • 2020
  • Ingår i: Journal of Endovascular Therapy. - : SAGE Publications. - 1526-6028 .- 1545-1550. ; 27:3, s. 468-472
  • Tidskriftsartikel (refereegranskat)abstract
    • Purpose: To validate a new 2D-3D registration method of fusion imaging during aortic repair in a system prepared only for 3D-3D registration and to compare radiation doses and accuracy. Materials and Methods: The study involved 189 patients, including 94 patients (median age 70 years; 85 men) who underwent abdominal endovascular aneurysm repair (EVAR) with 2D-3D fusion on an Artis zee imaging system and 95 EVAR patients (median age 70 years; 81 men) from a prior study who had 3D-3D registration done using cone beam computed tomography (CBCT). For the 2D-3D registration, an offline CBCT of the empty operating table was imported into the intraoperative dataset and superimposed on the preoperative computed tomography angiogram (CTA). Then 2 intraoperative single-frame 2D images of the skeleton were aligned with the patient’s skeleton on the preoperative CTA to complete the registration process. A digital subtraction angiogram was done to correct any misalignment of the aortic CTA volume. Values are given as the median [interquartile range (IQR) Q1, Q3]. Results: The 2D-3D registration had an accuracy of 4.0 mm (IQR 3.0, 5.0) after bone matching compared with the final correction with DSA (78% within 5 mm). By applying the 2D-3D protocol the radiation exposure (dose area product) from the registration of the fusion image was significantly reduced compared with the 3D-3D registration [1.12 Gy∙cm2 (IQR 0.41, 2.14) vs 43.4 Gy∙cm2 (IQR 37.1, 49.0), respectively; p<0.001). Conclusion: The new 2D-3D registration protocol based on 2 single-frame images avoids an intraoperative CBCT and can be used for fusion imaging registration in a system originally designed for 3D-3D only. This 2D-3D registration protocol is accurate and leads to a significant reduction in radiation exposure.
  •  
13.
  • Fransson, Torbjörn, et al. (författare)
  • Drug-eluting balloon (DEB) versus plain old balloon angioplasty (POBA) in the treatment of failing dialysis access : A prospective randomized trial
  • 2022
  • Ingår i: Journal of International Medical Research. - : SAGE Publications. - 0300-0605 .- 1473-2300. ; 50:3
  • Tidskriftsartikel (refereegranskat)abstract
    • Objective: To compare the efficacy of angioplasty using drug-eluting balloons (DEB) compared with plain old balloon angioplasty (POBA) to reduce the rate of restenosis. Methods: This prospective, single-centre, single-blinded, 1:1 randomized, clinical trial enrolled patients that had primary or restenotic lesions in native upper extremity arteriovenous (AV) fistulas or at the graft-venous anastomosis. Patients were randomized to angioplasty with a POBA or a DEB. The primary effectiveness endpoints were freedom from target lesion revascularization (TLR) and functional status of access circuit at 12 months. Results: A total of 42 (28 male, 14 female; age range, 42–83 years) patients were enrolled. Patients were followed for 12 months. No significant differences were detected between the POBA and DEB groups regarding total number of TLR procedures (31 versus 36, respectively), freedom from TLR (3 versus 4, respectively) and functional status of the access circuit at 12 months (14 of 20 patients [70%] versus 17 of 22 patients [77%], respectively). Conclusion: This clinical trial did not demonstrate any significant differences between DEB angioplasty and standard balloon angioplasty when treating dysfunctional haemodialysis access.
  •  
14.
  • Fransson, Torbjörn, et al. (författare)
  • Nationwide Study of the Outcome of Treatment of Lower Extremity Atherosclerotic Lesions With Endovascular Surgery With or Without Drug Eluting Methods in Patients With Diabetes
  • Ingår i: Journal of Endovascular Therapy. - 1526-6028.
  • Tidskriftsartikel (refereegranskat)abstract
    • Paclitaxel eluting balloons and stents reduce the development of intimal hyperplasia and restenosis rate after endovascular treatment for peripheral arterial disease (PAD) in the lower extremities. As diabetes mellitus (DM) worsens the prognosis in PAD patients after invasive endovascular treatment, we assessed the effects of drug eluting technology for PAD with special focus on effects in patients with and without DM. All Swedish patients registered in the Swedish vascular registry Swedvasc after vascular or endovascular surgery for intermittent claudication, IC; (n=1948) or chronic limb threatening ischemia, CLTI (n=3353) in 2013 to 2015 were followed up regarding a composite of either major amputation and/or mortality during median 607 days and for reinterventions for PAD during median 522 days. Patients with DM registered in the Swedish National Diabetes Registry (NDR) and patients without DM were evaluated separately. The 201 CLTI patients with DM treated with drug eluting methods had a lower adjusted risk for amputation or mortality after adjustment than the 1476 CLTI patients with DM treated without drug eluting methods (hazard ratio [HR] 0.712 [0.562-0.901], P=.005). There were no differences among IC patients. Regarding the need for reinterventions for PAD, there were no differences between patients treated with and without drug eluting methods, irrespectively of the presence or absence of DM. In conclusion, this nationwide follow-up study indicated potential benefits of drug eluting treatment in CLTI patients with diabetes. The results need to be evaluated and confirmed in prospective randomized studies. Clinical Impact: This retrospective observational registry trial combines national registries for vascular surgical procedures and diabetes mellitus to clarify results of drug eluting technology in treating diabetic subjects with intermittent claudication or chronic limb threatening ischemia compared to treatment of non-diabetic subjects. As earlier proposed and showed in this trial, there may be an implication for a beneficial treatment efficacy with drug eluting therapy in the diabetic population with PAD compared to the non-diabetic population. A finding worth further exploration.
  •  
15.
  • Fransson, Torbjörn, et al. (författare)
  • Randomized clinical Trial Comparing drug Eluting Stent Zilver PTX® Versus Bare Metal Stent Zilver Flex® for Treatment of Lesions in Femoral and Popliteal Arteries in Chronic Limb Threatening Ischemia
  • 2023
  • Ingår i: Vascular and Endovascular Surgery. - 1538-5744. ; 57:7, s. 706-716
  • Tidskriftsartikel (refereegranskat)abstract
    • Objective: Drug eluting stents (DES) might improve the results of stenting in the femoropopliteal (FP) segment, but randomized data between DES and BMS in the treatment of patients with chronic limb threatening ischemia (CLTI) is lacking. The aim of this study was to perform a randomized comparison, between DES and bare metal stent (BMS) implantation in a subgroup of CLTI patients with lesions in the superficial femoral artery (SFA) and the P1-P2 portion of the popliteal artery. Methods: Patients presenting with CLTI scheduled for endovascular treatment of FP lesions were randomly assigned by blinded envelopes 1:1 in a single blinded, parallel group design to DES or BMS after lesion crossing. Primary endpoints were target lesion revascularization (TLR) at 12 and 24 months and primary patency at 12 and 24 months. Secondary endpoints were technical success (TS), clinical success, secondary patency at 12 and 24 months, limb salvage, serious adverse events (SAE) at 24 month and survival at five years. Results: A total of 48 CLTI patients and 49 limbs, were enrolled, 22 in the BMS group and 27 in the DES group. Demographics, comorbidities, and Rutherford class were similar in both treatment arms. The overall rate of total occlusions was 96% and the corresponding overall median lesion length was 240 mm. No patients were lost to follow up. No significant differences were detected between groups regarding TLR and primary patency. The overall primary patency at 12 and 24 months was 42.9% and 36.7% respectively and the overall freedom from TLR was 67.3% and 61.2% respectively. The results in the two groups were also similar regarding secondary outcomes. Conclusions: This single centre, randomized study could not demonstrate superiority of DES compared to BMS when treating long FP lesions in patients with CLTI but was limited by insufficient patient inclusion.
  •  
16.
  • Hammo, Sari, et al. (författare)
  • Outcome After Endovascular Repair of Ruptured Descending Thoracic Aortic Aneurysm : A National Multicentre Study
  • 2019
  • Ingår i: European Journal of Vascular and Endovascular Surgery. - : Saunders Elsevier. - 1078-5884 .- 1532-2165. ; 57:6, s. 788-794
  • Tidskriftsartikel (refereegranskat)abstract
    • Objective: The purpose of this multicentre study was to analyse the outcome of thoracic endovascular aortic repair (TEVAR) in patients with ruptured descending thoracic aortic aneurysm (rDTAA).Methods: This is a nationwide retrospective study including all patients who underwent TEVAR for rDTAA at six major vascular university centres in Sweden between January 2000 and December 2015. Outcome measures were analysed using Kaplan-Meier estimator and multivariable Cox regression.Results: There were 140 patients (age [mean +/- SD] 74.1 +/- 8.8 years; 56% men; aneurysm size 64.8 +/- 19 mm), with rDTAA. In 53 patients (37.9%), the left subclavian artery was covered, and in 25 patients (17.9%) arch vessel revascularisation was performed. In total, 61/136 patients (45%) had a major complication within 30 days post TEVAR. Stroke (n = 20; 14.7%) was the most common complication, followed by paraplegia (n = 13; 9.6%) and major bleeding (n = 13; 9.6%). TEVAR related complications during follow up included endoleaks 22.1% (30/136; 14 type 1a, six type 1b, 10 not defined). In total, re-interventions (n = 31) were required in 27/137 (19.7%) patients. The median follow up time was 17.0 months (range 0-132 months). The Kaplan-Meier estimated survival was 80.0% at one month, 71.7% at three months, 65.3% at one year, 45.9% at three years, and 31.9% at five years. Age (HR 1.03; 95% CI 1.00-1.07; p = .046), history of stroke (HR 2.35; 95% CI 1.194.63; p = .014), previous aortic surgery (HR 2.11; 95% CI 1.15-3.87; p = .016) as well as post-operative major bleeding (HR 4.40; 95% CI 2.20-8.81; p = .001), stroke (HR 2.63; 95% CI 1.37-5.03; p = .004), and renal failure (HR 8.25; 95% CI 2.69-25.35; p = .001) were all associated with mortality.Conclusions: This nationwide multicentre study of patients with rDTAA undergoing TEVAR showed acceptable short- but poor long-term survival. Adequate proximal and distal aortic sealing zones are important for technical success. High risk patients and post-operative complications need to be further addressed in an effort to improve outcome.
  •  
17.
  • Haulon, Stéphan, et al. (författare)
  • Global experience with an inner branched arch endograft.
  • 2014
  • Ingår i: Journal of Thoracic and Cardiovascular Surgery. - : Elsevier BV. - 1097-685X .- 0022-5223. ; 148:4, s. 1709-1716
  • Tidskriftsartikel (refereegranskat)abstract
    • Branched endografts are a new option to treat arch aneurysm in high-risk patients.
  •  
18.
  • Karelis, Angelos, et al. (författare)
  • Iliac Branch Devices in the Repair of Ruptured Aorto-iliac Aneurysms: A Multicenter Study
  • 2023
  • Ingår i: Journal of Endovascular Therapy. - : SAGE PUBLICATIONS INC. - 1526-6028 .- 1545-1550.
  • Tidskriftsartikel (refereegranskat)abstract
    • Purpose: To evaluate the outcomes of preserving the internal iliac artery (IIA) with iliac branched devices (IBDs) during acute endovascular repair of ruptured aortoiliac aneurysms. Material and Methods: This is a multicenter retrospective review of all consecutive patients undergoing acute endovascular repair of ruptured aortoiliac aneurysm with an IBD at 8 aortic centers between December 2012 and June 2020. A control group was used where the IIA was intentionally occluded from the same study period. The main outcome measures were 30-day mortality, major adverse events, technical success, and clinical success. Secondary outcomes were buttock claudication, primary patency, primary-assisted and secondary patency of the IBD, occurrence of endoleak types I/III, and reintervention. Values are presented as numbers and percentages or interquartile range in parenthesis. Results: Forty-eight patients were included in the study: 24 with IBD and 24 with IIA occlusion. There was no difference in demographics, cardiovascular risk factors, and aneurysm extent. Twenty (83%) of them were hemodynamically stable during the procedure as opposed to 14 (58%, p=.23) with the IIA occlusion. Technical success was achieved in all cases with a procedure time of 180 (133-254) minutes, 45 (23-65) of which were from IBD. There were 2 (8%) deaths during the first 30 days and 2 (8%) major complications unrelated to the IBD, whereas in the IIA occlusion, the figures were 10 (42%) and 7 (29%), respectively. No patient in the IBD group developed buttock claudication compared to 8 (57%, p<.0001) in the IIA occlusion group; 1 (4%) patient developed bowel ischemia on both groups, with 1 in the IIA occlusion group needing resection. The median follow-up duration was 17 months (interquartile range 2-39) for the IBD group, with a primary patency of 60 +/- 14% at 3 years that went up to 92 +/- 8% with reinterventions (8 reinterventions in 6 patients). When the first 90 days were disregarded, there were no differences in survival between the groups. Conclusion: IBD is a valid alternative for maintaining the pelvic circulation for endovascular aortic aneurysm repair of ruptured aortoiliac aneurysms. The technical success and midterm outcomes are very satisfactory but require patient selection particularly regarding hemodynamic stability. The reintervention rate is considerable, mandating continuous follow-up. Clinical Impact This multicenter study demonstrates that ruptured aortoiliac aneurysms do not necessarily require mandatory occlusion of hypogastric arteries. Iliac branch devices are shown to be a valid alternative in highly selected cases, with good midterm results, even if reinterventions are required in a significant proportion of patients.
  •  
19.
  • Kristmundsson, Thorarinn, et al. (författare)
  • A Novel Method to Estimate Iliac Tortuosity in Evaluating EVAR Access
  • 2012
  • Ingår i: Journal of Endovascular Therapy. - : International Society of Endovascular Specialists. - 1545-1550 .- 1526-6028. ; 19:2, s. 157-164
  • Tidskriftsartikel (refereegranskat)abstract
    • Purpose: To subjectively and objectively evaluate the methods used for preoperative assessment of iliac artery tortuosity in patients with abdominal aortic aneurysms (AAA). Methods: Iliac artery tortuosity was assessed retrospectively in 188 patients (160 men; mean age 73 years) diagnosed with AAA at our clinic in 2006 and 2007. All patients underwent preoperative computed tomography (CT) with predominantly thin-slice acquisitions. CT data were analyzed in a dedicated 3-dimensional workstation to perform centerline-of-flow measurements on 376 iliac arteries. Iliac tortuosity was evaluated using the following methods: (1) subjective grading (none, mild, moderate, severe) by 2 experienced observers, (2) calculating the modified iliac tortuosity index based on the published reporting standards for endovascular aneurysm repair, and (3) using the shortest distance between the aortic bifurcation and the common femoral artery (CFA) on axial CT scans as a surrogate for the tortuosity index. Correlation between the objective methods was assessed, and all 3 methods were evaluated for intra- and interobserver agreement. Results: (1) The intra- and interobserver agreement was substantial (κ = 0.71 and κ = 0.65, respectively) for subjective grading, but few variations were found in the calculated tortuosity indexes between the subjective groups. (2) Intra- and interobserver correlations when measuring the iliac tortuosity index were strong (r = 0.94 and r = 0.79, respectively), with good intra- and interobserver agreement. (3) The new method had a strong correlation with iliac tortuosity index (r = 0.78); segregating the iliac arteries into 3 length categories (<10 cm, 10-15 cm, >15 cm), the mean iliac tortuosity indexes were 2.0±0.37, 1.6±0.21, and 1.1±0.27, respectively (p<0.001). This strong correlation was not seen when measuring the iliac artery length in CLF reconstruction (r = 0.31), proving little variation in CLF length among patients. Conclusion: Subjective grading of iliac artery tortuosity had substantial agreement between investigators but cannot be recommended as a surrogate for the tortuosity index in access evaluation. The iliac artery tortuosity index is most accurate, but complex and time-consuming. As the CLF length varies only slightly among patients, the new method using the shortest aortic bifurcation-CFA distance on an axial CT scan is a good substitute for the iliac tortuosity index and can often replace it clinically.
  •  
20.
  • Kristmundsson, Thorarinn, et al. (författare)
  • Anatomic suitability for endovascular repair of abdominal aortic aneurysms and possible benefits of low profile delivery systems.
  • 2014
  • Ingår i: Vascular. - : SAGE Publications. - 1708-539X .- 1708-5381. ; 22:2, s. 112-115
  • Tidskriftsartikel (refereegranskat)abstract
    • The aim of the study was to evaluate the anatomic suitability for endovascular abdominal aneurysm repair (EVAR) according to instructions for use (IFUs) of three commercially available bifurcated stent graft devices and explore the possible benefits of low-profile delivery systems. Computed tomography scans of 241 patients with abdominal aortic aneurysm (AAA) were evaluated for suitability of Zenith Flex(®), Gore Excluder(®) and Endurant(®) bifurcated stent graft systems according to their IFUs. The most common exclusion criteria and possible benefits of smaller diameter delivery systems were analyzed. When choosing the most suitable graft model for each patient, the overall suitability was 49.4%. By brand, the suitability was 28.6% for Zenith(®), 25.7% for Gore Excluder(®) and 48.1% for Endurant(®). By step wise accepting iliac diameters of ≥6 mm, ≥5 mm and ≥4 mm the overall suitability increased to 56.7, 58.9 and 60.2%, respectively (P < 0.001). Diameters below 4 mm had no additional effect on suitability as combinations of other anatomical features, with or without narrow iliacs, accounted for the remaining excluding factors. In conclusion, Less than half of patients with AAAs are suitable for EVAR according to current IFUs. Low-profile delivery systems may allow for endovascular treatment in up to 60% of patients.
  •  
21.
  • Kristmundsson, Thorarinn, et al. (författare)
  • Association Between the SVS/AAVS Anatomical Severity Grading Score and Operative Outcomes in Fenestrated Endovascular Repair of Juxtarenal Aortic Aneurysm.
  • 2013
  • Ingår i: Journal of Endovascular Therapy. - 1545-1550. ; 20:3, s. 356-365
  • Tidskriftsartikel (refereegranskat)abstract
    • Purpose : To evaluate the association between the Society for Vascular Surgery/American Association for Vascular Surgery (SVS/AAVS) anatomical severity grading (ASG) score and operative outcomes in fenestrated endovascular repair (f-EVAR) for juxtarenal aortic aneurysm. Methods : A review was conducted of all patients treated at our clinic with commercially available, custom-made f-EVAR devices between June 2007 and December 2011. Preoperative computed tomography (CT) scans were analyzed in a dedicated vascular 3-dimensional workstation for calculation of the ASG score. Of the 100 patients treated with f-EVAR during the study period, 88 (69 men; mean age 70 years, range 50-82) had high quality CT scans available for generating semiautomatic centerline-of-flow reconstructions needed to calculate the ASG score. The mean score was used to divide the patients into high and low score groups for comparison of operative outcomes. Results : A total ASG score ≥24 was associated with longer procedure time (357±121 vs. 298±131 minutes, p=0.03) and more frequent intraoperative adjunctive maneuvers (48% vs. 29% of patients, p=0.05). An ASG neck score ≥7 was associated with longer procedure time (365±126 vs. 288±119 minutes, p<0.01), more operative adverse events (31% vs. 14% of patients, p=0.05), higher radiation exposure (53828±37341 vs. 38788±25846 μGym (2) , p=0.04), and more frequent postoperative complications (46% vs. 18% of patients, p<0.01). An ASG aneurysm score ≥5 was associated with operative adverse events (44% vs. 19% of patients, p=0.04). No relationship was found between the ASG score and blood loss, contrast volume, fluoroscopy time, or hospital stays. Conclusion : The ASG score is associated with operative adverse events, intraoperative adjunctive maneuvers, radiation exposure, and postoperative complications in patients treated with f-EVAR for juxtarenal aortic aneurysm.
  •  
22.
  • Kristmundsson, Thorarinn, et al. (författare)
  • Fenestrated endovascular repair for juxtarenal aortic pathology.
  • 2009
  • Ingår i: Journal of vascular surgery : official publication, the Society for Vascular Surgery [and] International Society for Cardiovascular Surgery, North American Chapter. - : Elsevier BV. - 1097-6809. ; 49, s. 568-574
  • Tidskriftsartikel (refereegranskat)abstract
    • OBJECTIVE: To evaluate the outcomes after fenestrated endovascular aortic repair (f-EVAR) in a tertiary European referral center. METHODS: All patients treated with commercially available custom-made f-EVAR between September 2002 and June 2007 were prospectively enrolled in a computerized database including co-morbidities and aneurysm morphology. Patients were retrospectively analyzed. Follow-up consisted of clinical examinations and computed tomography (CT) scanning. RESULTS: A total of 54 patients were included in this study. Median age was 72 (interquartile range [IQR] 68-76) years and 85% were men. Median preoperative aneurysm diameter was 60 (53-66) mm. One hundred thirty-four vessels were targeted (43 scallops, 91 fenestrations) and 96 stents were placed (69 bare, 27 covered). Target vessel catheterization was achieved in 98% of cases. Two patients (3.7%) died within 30 days, 1 from trash embolization and multiorgan failure and 1 from retroperitoneal bleeding caused by a renal artery perforation. Three type I endoleaks occurred intraoperatively, two sealed pre-discharge and one was treated with a Palmaz stent (Cordis, Miami Lakes, Fla) on postoperative day 4. Thirteen patients had type II endoleaks, and 2 required treatment. The median clinical follow-up was 25 (12-32) months with median CT follow-up of 22 (4-26) months. Aneurysm diameter decreased >/=5 mm in 47%, was unchanged in 50%, and increased >/=5 mm in 3% of patients at 1 year. There were three type II endoleaks at 1-year follow-up, one of which was successfully treated after 19 months due to aneurysm growth. Ninety-six percent of target vessels remained patent during the study period and all occlusions occurred within the first year of follow-up. Five target vessels occluded (2 renal arteries [RAs] and 3 superior mesenteric arteries [SMAs]) without symptoms during follow-up and successful reinterventions were done on 2 stenosed RAs. Three patients suffered creatinine increase but none needed dialysis. One late aneurysm-related death occurred due to massive bleeding during redo surgery for infection. CONCLUSION: Despite complex anatomy or severe comorbidities in these patients f-EVAR has acceptable short- and midterm results in this series which includes a learning curve and offers a valid treatment alternative to patients unsuitable for standard EVAR or open repair.
  •  
23.
  •  
24.
  • Kölbel, Tilo, et al. (författare)
  • Staged proximal deployment of the Zenith TX2 thoracic stent-graft: a novel technique to improve conformance to the aortic arch.
  • 2009
  • Ingår i: Journal of Endovascular Therapy. - : International Society of Endovascular Specialists. - 1545-1550 .- 1526-6028. ; 16:5, s. 598-602
  • Tidskriftsartikel (refereegranskat)abstract
    • PURPOSE: To present a modification of the Zenith TX2 thoracic stent-graft that allows staged proximal deployment to improve apposition to the aortic wall. TECHNIQUE: Three standard Zenith TX2 thoracic stent-grafts and 3 modified versions were deployed in a glass model of the aortic arch. Deployment sequences were analyzed. In a patient with a 6-cm thoracic aortic aneurysm after a type B dissection, the modified Zenith TX2 thoracic stent-graft was deployed successfully and without complications; the proximal part of the stent-graft protruded less into the arch, significantly improving wall apposition. CONCLUSION: Staged proximal deployment with a modified Zenith TX2 thoracic stent-graft can improve orientation and wall apposition of the first Z stent. A better proximal apposition may prevent early and late stent-graft complications.
  •  
25.
  • Malina, Martin, et al. (författare)
  • Feasibility of a branched stent-graft in common iliac artery aneurysms.
  • 2006
  • Ingår i: Journal of Endovascular Therapy. - 1545-1550. ; 13:4, s. 496-500
  • Tidskriftsartikel (refereegranskat)abstract
    • Purpose: To evaluate the short-term feasibility, efficacy, and safety of a modular bifurcated stent-graft with an internal iliac artery (IIA) side branch for endovascular repair of aortoiliac aneurysms. Methods: Between 2002 and 2005, 10 male patients (median age 75 years, range 59–83) were treated with a bifurcated stent-graft that included a unilateral side branch for the IIA. The median diameters of the abdominal aortic and common iliac artery (CIA) aneurysms were 56 mm (range 33–80) and 40 mm (range 27–60), respectively. Four patients were treated mainly for the CIA aneurysm. Postoperative endoleaks, patency rate, and vessel morphology were determined with contrast-enhanced computed tomography (CT). Results: All endografts were implanted in the desired position. One IIA occluded intraoperatively, and 1 external iliac artery occlusion was noted 6 months postoperatively; both occlusions were asymptomatic and remain untreated. Three graft-related endoleaks were treated with implantation of adjunctive stent-grafts (2 intraoperative and 1 late). Median follow-up by CT was 2 months (1 week to 32 months). One patient died of myocardial infarction 13 days postoperatively; the stent-graft was patent at autopsy. Conclusion: Stent-grafts with an IIA side branch offer an opportunity to repair aortoiliac aneurysms without sacrificing the IIA. Implantation of the IIA branch is more complex than routine endovascular aneurysm repair and may have contributed to a periprocedural cardiac death. More patients and longer follow-up are needed to verify these data.
  •  
26.
  • Manning, Brian J, et al. (författare)
  • Abdominal aortic aneurysm diameter: a comparison of ultrasound measurements with those from standard and three-dimensional computed tomography reconstruction.
  • 2009
  • Ingår i: Journal of vascular surgery : official publication, the Society for Vascular Surgery [and] International Society for Cardiovascular Surgery, North American Chapter. - : Elsevier BV. - 1097-6809. ; 50:2, s. 263-268
  • Tidskriftsartikel (refereegranskat)abstract
    • OBJECTIVE: Aortic aneurysm size is a critical determinant of the need for intervention, yet the maximal diameter will often vary depending on the modality and method of measurement. We aimed to define the relationship between commonly used computed tomography (CT) measurement techniques and those based on current reporting standards and to compare the values obtained with diameter measured using ultrasound (US). METHODS: CT scans from patients with US-detected aneurysms were analyzed using three-dimensional reconstruction software. Maximal aortic diameter was recorded in the anteroposterior (CT-AP) plane, along the maximal ellipse (CT-ME), perpendicular to the maximal ellipse (CT-PME), or perpendicular to the centerline of flow (CT-PCLF). Diameter measurements were compared with each other and with maximal AP diameter according to US (US-AP). Analysis was performed according to the principles of Bland and Altman. Results are expressed as mean +/- standard deviation. RESULTS: CT and US scans from 109 patients (92 men, 17 women), with a mean age of 72 +/- 8 years, were included. The mean of each series of readings on CT was significantly larger than the mean US-AP measurement (P < .001), and they also differed significantly from each other (P < .001). The CT-PCLF diameter was larger than CT-AP and CT-PME by mean values of 3.0 +/- 6.6 and 5.9 +/- 6.0 mm, respectively. The CT-ME diameter was larger than CT-PCLF by a mean of 2.4 +/- 5 mm. The US-AP diameter was smaller than CT-AP diameter by 4.2 +/- 4.9 mm, CT-ME by 9.6 +/- 8.0 mm, CT-PME by 1.3 +/- 5 mm, and smaller than CT-PCLF by 7.3 +/- 7.0 mm. Aneurysm size did not significantly affect these differences. Seventy-eight percent of 120 pairs of intraobserver CT measurements and 65% of interobserver CT measurements differed by <2 mm. CONCLUSIONS: CT-based measurements of aneurysm size tend to be larger than the US-AP measurement. CT-PCLF diameters are consistently larger than CT-PME as well as CT-AP measurements. These differences should be considered when applying evidence from previous trials to clinical decisions.
  •  
27.
  • Manning, Brian J, et al. (författare)
  • Endovascular treatment for chronic type B dissection: limitations of short stent-grafts revealed at midterm follow-up.
  • 2009
  • Ingår i: Journal of Endovascular Therapy. - : International Society of Endovascular Specialists. - 1545-1550 .- 1526-6028. ; 16:5, s. 590-597
  • Tidskriftsartikel (refereegranskat)abstract
    • PURPOSE: To examine the incidence of and the indications for re-intervention, as well as the changes in aortic morphology, in patients with chronic type B aortic dissection who underwent endovascular intervention for false lumen aneurysms. METHODS: A retrospective analysis was conducted of 10 patients (8 men; mean age 63 years, range 45-79) who underwent stent-graft repair of aneurysmal false lumen expansion related to chronic type B aortic dissection at a median 16 months (range 2-71) from the initial diagnosis. All grafts had been oversized by 10% relative to the normal non-dissected aorta and were implanted to cover the primary entry tear. Follow-up computed tomography scans were analyzed to define changes in aortic morphology. RESULTS: Mean radiological follow-up was 56 months (median 64.5; range 19-86.5). There was no perioperative mortality or stroke; no cases of aortic rupture were recorded during follow-up. One patient suffered a procedure-related stroke with postoperative hemiparesis following re-intervention for proximal erosion 15 months after the initial treatment. In 6 of the 7 re-interventions performed in 6 patients at a median 42 months after the index procedure, stent-graft extension was required to treat erosion of the dissection membrane that had resulted in endoleak with false lumen reperfusion. The extent of dissection, duration of follow-up, or length of aortic coverage was not predictive of the need for re-intervention during follow-up. At last follow-up, the mean false lumen diameter at the level of the stented aorta was significantly smaller than at baseline (11+/-15 versus 24+/-15 mm, p<0.01). This was associated with false lumen thrombosis at the level of the stent-graft in 9 of 10 cases, although 7 patients had persistent false lumen perfusion distal to the stent-graft. CONCLUSION: Endovascular stent-graft treatment is effective therapy for chronic type B dissection patients with false lumen aneurysms. Erosion of the dissection membrane, causing proximal or distal endoleak, is the most common reason for re-intervention during midterm follow-up.
  •  
28.
  •  
29.
  • Mathisen, Sven Ross, et al. (författare)
  • Kissing stents in the common femoral artery bifurcation for critical limb ischemia: Technical description and report of three cases
  • 2007
  • Ingår i: Vascular. - : SAGE Publications. - 1708-539X .- 1708-5381. ; 15:4, s. 211-214
  • Tidskriftsartikel (refereegranskat)abstract
    • The purpose of this article is to describe three cases of kissing stent placement in the common femoral artery bifurcation in patients unsuitable for open endarterectomy and patch plasty. In three patients with critical limb ischemia, caused by primary atherosclerotic disease or dissection-related injury when performing a lower extremity intervention, a technique of kissing stents was used to treat the flow-obstructing lesion in the common femoral artery bifurcation. Technical success was uniform, and during follow-up (4.5-8 months), all patients showed improved symptoms, wound healing, and duplex ultrasonography-verified patency of the stents. Kissing stents in the common femoral artery bifurcation are a feasible treatment option in patients with limited mobililty or contraindications to open repair. The short-term results seem promising, but longer follow-up and an increased number of patients will be needed to assess the durability of the reconstruction.
  •  
30.
  • Mehmedagic, Irma, et al. (författare)
  • Complications to Cerebrospinal Fluid Drainage and Predictors of Spinal Cord Ischemia in Patients With Aortic Disease Undergoing Advanced Endovascular Therapy
  • 2013
  • Ingår i: Vascular and Endovascular Surgery. - : SAGE Publications. - 1938-9116 .- 1538-5744. ; 47:6, s. 415-422
  • Tidskriftsartikel (refereegranskat)abstract
    • Objective: To study the complications after cerebrospinal fluid (CSF) drainage and predictors of spinal cord ischemia (SCI) after advanced endovascular therapy with CSF drainage for complex aortic disease. Methods: Between 2009 and 2012, 88 attempts of CSF drainage insertions/84 operations/83 patients, of the 658 operations for aortoiliac diseases, were performed. Results: Indications for therapy were aortic dissection (n = 13) and aortic aneurysm (n = 70), of whom 38 had thoracoabdominal aortic aneurysm (TAAA). In all, 10 had ruptured aorta. The CSF drainages were inserted preoperatively (n = 75) and postoperatively (n = 9). In all, 14 CSF drainages were nonfunctioning. The SCI was present in 29 patients, transient/permanent in 12/17. Intraoperative circulatory instability (P = .001) and operation for TAAA, type II (P = .036), were associated with SCI. Meningitis (n = 1), epidural (n = 1), and subdural (n = 2) hematoma and needle-mediated paresis in 1 leg (n = 1) occurred after CSF drainage. Conclusions: Complication to CSF drainage occurred too frequently in this selected group of patients with high rate of SCI.
  •  
31.
  •  
32.
  • Montan, Carl, et al. (författare)
  • Short- and midterm results of the fascia suture technique for closure of femoral artery access sites after endovascular aneurysm repair.
  • 2011
  • Ingår i: Journal of Endovascular Therapy. - : International Society of Endovascular Specialists. - 1545-1550 .- 1526-6028. ; 18:6, s. 789-796
  • Tidskriftsartikel (refereegranskat)abstract
    • Abstract Purpose: To evaluate the midterm outcomes and potential risk factors associated with the fascia suture technique (FST) for closure of femoral artery access sites after percutaneous endovascular aneurysm repair (EVAR). Methods: Between April 2007 and April 2008, 100 consecutive EVAR cases were evaluated retrospectively. A third of the procedures were emergent (16 ruptured aneurysms). Of the 187 femoral access sites, 160 (85.5%) were closed by the FST as a first choice. Pre- and postoperative chart and imaging data were collected from computerized medical records for analysis of demographics and the rate of complications (bleeding, infection, thrombosis, pseudoaneurysms, and stenosis). Preoperative risk factors for FST failure were analyzed with regard to obesity (based on the subcutaneous fat layer), plaque at the femoral access site, and stenosis based on the pre- and 1-year postoperative computed tomography scans. Results: Of the 160 FST closures, 146 (91.3%) were technically successful. The 14 (8.8%) technical failures were converted to open cutdown intraoperatively because of bleeding (11, 6.8%), inadequate limb perfusion (2, 1.2%), and a broken guidewire (1, 0.6%). Two (1.2%) pseudoaneurysms required surgical repair after 2 weeks. Data from the 1-year follow-up showed no signs of increased stenosis, thrombosis, or formation of plaque. Nine small (<1 cm(3)) pseudoaneurysms were detected and managed conservatively. No preoperative risk factors were associated with FST failure. Conclusion: The fascia suture technique seems to be safe, effective, and simple to use for closing percutaneous access sites after EVAR. Complications are rare, and the outcome is not affected by obesity, femoral calcification, or femoral artery stenosis.
  •  
33.
  •  
34.
  •  
35.
  • Ohrlander, Tomas, et al. (författare)
  • The chimney graft: a technique for preserving or rescuing aortic branch vessels in stent-graft sealing zones.
  • 2008
  • Ingår i: Journal of Endovascular Therapy. - : International Society of Endovascular Specialists. - 1545-1550 .- 1526-6028. ; 15:4, s. 427-432
  • Tidskriftsartikel (refereegranskat)abstract
    • PURPOSE: To report an alternative to the fenestrated stent-graft for preserving blood flow to side branches in the sealing zones of aortic stent-grafts. TECHNIQUE: A covered stent is deployed parallel to the main aortic stent-graft, protruding somewhat proximally, like a chimney, to preserve flow to a vital side branch covered by the aortic stent-graft. Use of a chimney graft makes it possible to use standard off-the-shelf stent-grafts to instantly treat lesions with inadequate fixation zones, providing an alternative to fenestrated stent-grafts in urgent cases, in aneurysms with challenging neck morphology, and for reconstituting an aortic side branch unintentionally compromised during endovascular repair. This technique has been used successfully in 10 patients, combining chimney grafts in the renal, superior mesenteric, left subclavian, left common carotid, and innominate arteries with stent-grafts in the abdominal (n=6) or thoracic (n=4) aorta. There has been no late chimney graft-related endoleak on imaging studies up to 8 months. CONCLUSION: The use of chimney grafts is feasible in the renal and superior mesenteric arteries, as well as in the supra-aortic branches, to facilitate stent-graft repair of thoracic or abdominal aortic lesions with inadequate fixation zones.
  •  
36.
  •  
37.
  • Resch, Timothy A, et al. (författare)
  • Chimney Grafts: Is There a Need and Will They Work?
  • 2011
  • Ingår i: Perspectives in Vascular Surgery and Endovascular Therapy. - : SAGE Publications. - 1531-0035.
  • Tidskriftsartikel (refereegranskat)abstract
    • Endovascular repair has become the primary treatment option for abdominal aortic aneurysms over the past decade. The favorable results as well as technical evolution have led endovascular repair to include fenestrated and branched technology for complex juxtarenal, suprarenal, and thoracoabdominal aneurysms. These grafts are, however, extensively customized and patient tailored at present precluding their use in emergency situations. Certain aspect of aneurysm anatomy also limits them. The chimney technique uses standard, off-the-shelf endovascular devices that extend the use of standard aortic stent grafts for aneurysms without suitable proximal landing zones particularly in acute situations. Early results are promising and warrant a continued development of the technique until such time that dedicated devices are available for the treatment of these complex aneurysms.
  •  
38.
  •  
39.
  • Resch, Timothy A, et al. (författare)
  • Endovascular techniques in acute arterial mesenteric ischemia.
  • 2010
  • Ingår i: Seminars in Vascular Surgery. - : Elsevier BV. - 0895-7967. ; 23:1, s. 29-35
  • Tidskriftsartikel (refereegranskat)abstract
    • Rapid developments in preoperative noninvasive imaging as well as advanced endovascular techniques have made endovascular treatment of acute arterial mesenteric ischemia a feasible treatment option in many patients. Multidetector computed tomographic angiography will provide the diagnosis and guide treatment in most cases. The use of mechanical and aspiration embolectomy, sometimes in combination with thrombolytic therapy, is often successful in offering these very sick patients a good treatment option to open surgical revascularization. Underlying occlusive lesions can be treated in the same setting. Hybrid techniques using open abdominal exploration in combination with endovascular tools have the possibility of offering minimally invasive treatment to even more patients. Access to a hybrid operating room is very advantageous when performing these operations because it allows for performing both open and endovascular interventions in the same setting. A fixed angiographic system also minimizes radiation exposure and improves the imaging capabilities compared to a conventional, mobile C-arm. These tools must be used in conjunction with wise, careful clinical evaluation of the patient.
  •  
40.
  • Resch, Timothy, et al. (författare)
  • Changes in aneurysm morphology and stent-graft configuration after endovascular repair of aneurysms of the descending thoracic aorta
  • 2001
  • Ingår i: Journal of Thoracic and Cardiovascular Surgery. - : Elsevier BV. - 1097-685X .- 0022-5223. ; 122:1, s. 47-52
  • Tidskriftsartikel (refereegranskat)abstract
    • OBJECTIVE: We sought to study changes in morphology and stent-graft configuration of descending thoracic aortic aneurysms after endovascular repair. METHODS: Twenty-three patients treated with custom-made stent-grafts were studied. The stent-graft consisted of continuous, stainless-steel Z stents mounted within a polyester graft. In the last 11 cases the stents were interconnected with 3 longitudinal wires. Contrast-enhanced spiral computed tomography was performed preoperatively and at 1, 3, and every 6 months postoperatively. Angiography was used preoperatively and at 1-year follow-up. Proximal and distal necks were assessed for diameter and length. Aneurysm diameter, endoleaks, stent-graft migration, and changes in stent-graft configuration were evaluated. RESULTS: During follow-up (median, 18 months; range, 1-48 months), excluded aneurysms decreased in diameter by 4 mm (0.5-10 mm, P =.0018). Endoleaks prevented size decrease. Five patients displayed neck dilatation, 4 at both the proximal and distal fixation sites and 1 only distally. In 7 (30%) patients there was proximal migration of the distal end of the stent-graft. Three (13%) patients displayed both distal migration of the proximal end of the stent-graft and proximal migration of the distal end of the stent-graft. There was a significant correlation between stent-graft kinking and appearance of proximal or distal stent-graft migration (P =.05 and P =.0007, respectively). In no case did the migration lead to appearance of an endoleak before intervention was performed. CONCLUSION: Excluded descending thoracic aortic aneurysms decrease in size on midterm follow-up. A subgroup of patients prone to neck dilatation might exist. A combination of neck dilatation and vector forces acting on stent-grafts in the tortuous thoracic aorta might lead to stent-graft migration.
  •  
41.
  •  
42.
  • Resch, Timothy, et al. (författare)
  • The evolution of Z stent-based stent-grafts for endovascular aneurysm repair: a life-table analysis of 7.5-year followup.
  • 2002
  • Ingår i: Journal of the American College of Surgeons. - 1879-1190. ; 194:1 Suppl, s. 74-78
  • Tidskriftsartikel (refereegranskat)abstract
    • BACKGROUND: The purpose of this study was to analyze the impact of stent-graft design and operator skills on outcomes after endovascular abdominal aortic aneurysm repair. STUDY DESIGN: One hundred sixty-four patients (mean age 71 years) underwent stent-graft repair. Patients were treated with four different types of stent-graft: first-generation (n = 58) and second-generation (n = 17) Ivancev-Malmö monoiliac stent-grafts (IM I and IM II, respectively) combined with femoral-femoral crossover, Chuter bifurcated stent-graft (n = 15), and the Zenith stent-graft (n = 74). Patients underwent digital subtraction angiography and contrast CT preoperatively and were then followed with CT scans postoperatively. Recently, followup was changed to CT scanning at 1 month and 1 year postoperatively and annually thereafter. Ultrasonographic duplex scanning substitutes in the remaining followup. Changes in aneurysm diameters and occurrence of endoleaks were recorded. Short- and midterm mortality and complications and postoperative secondary interventions were recorded, and life-table analysis for intervention-free stent-graft survival was calculated. RESULTS: Immediate and late conversions and 30-day mortality were reduced for second- (IM II and Zenith) compared with first-generation stent-grafts (IM I and Chuter). Stent-graft migrations occurred only with the IM I and Chuter stent-grafts. Type I endoleak was significantly more common in first-generation stent-grafts. First-generation stent-grafts required significantly more secondary interventions than second-generation stent-grafts up to 30 months postoperatively. CONCLUSION: Enhanced stent-graft design has improved the probability of stent-graft success after endovascular abdominal aortic aneurysm repair. Better technical skills and increased use of intraoperative adjunctive procedures may also have contributed to improved results.
  •  
43.
  • Rudolph, Claudina, et al. (författare)
  • Scandinavian trial of uncomplicated aortic dissection therapy : study protocol for a randomized controlled trial
  • 2023
  • Ingår i: Trials. - : BioMed Central (BMC). - 1745-6215. ; 24:1
  • Tidskriftsartikel (refereegranskat)abstract
    • BackgroundContemporary management of uncomplicated type B aortic dissections (uTBAD) is based on the acuity and various morphological features. Medical therapy is mandatory, while the risks of early thoracic endovascular aortic repair (TEVAR) are balanced against the potential for rupture, complex surgery, and death. Improved aortic morphology following TEVAR is documented, but evidence for improved overall survival is lacking. The costs and impact on quality of life are also needed.MethodsThe trial is a randomized, open-label, superiority clinical trial with parallel assignment of subjects at 23 clinical sites in Denmark, Norway, Sweden, Finland, and Iceland. Eligibility includes patients aged ≥ 18 with uTBAD of < 4 weeks duration. Recruited subjects will be randomized to either standard medical therapy (SMT) or SMT + TEVAR, where TEVAR must be performed between 2–12 weeks from the onset of symptoms.DiscussionThis trial will evaluate the primary question of whether early TEVAR improves survival at 5 years among uTBAD patients. Moreover, the costs and the impact on quality of life should provide sorely needed data on other factors that play a role in treatment strategy decisions. The common Nordic healthcare model, with inclusion of all aortic centers, provides a favorable setting for carrying out this trial, while the robust healthcare registries ensure data validity.
  •  
44.
  • Singh, Bharti, et al. (författare)
  • Simple diameter measurements with ultrasound can be safely used to follow the majority of patients after infrarenal endovascular aneurysm repair
  • 2021
  • Ingår i: International Angiology. - 0392-9590. ; 40:5, s. 425-434
  • 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.
  •  
45.
  • Sobocinski, Jonathan, et al. (författare)
  • Malperfusions in Acute Type B Aortic Dissection—Predictors of Outcomes
  • 2019
  • Ingår i: Annals of Vascular Surgery. - : Elsevier BV. - 0890-5096. ; 59, s. 119-126
  • Tidskriftsartikel (refereegranskat)abstract
    • Background: Acute type B aortic dissection (AoD) with malperfusion is a rare and complex disease. In this specific setting, invasive treatment is generally required to improve aortic branch vessel flow. Thoracic aorta stent grafting (TEVAR) of the proximal descending thoracic aorta to cover/exclude the proximal intimal entry tear would promote resolution of the dynamic component (the most prevalent) of the malperfusion conflict by redirecting the flow within the true lumen. The aim was to study outcomes of patients undergoing TEVAR for acute (<14 days) type B AoD complicated with malperfusion and to depict any preoperative and intraoperative predictors that could affect the prognosis of those patients. Methods: From March 2005 to January 2016, all patients treated with TEVAR for acute type B AoD with malperfusion in 2 European high-volume aortic centers were retrospectively studied. Preoperative, intraoperative, and postoperative details were collected. Preoperative computed tomography angiogram was reanalyzed on a dedicated 3D workstation (Aquarius iNtuition Viewer, TeraRecon). Thirty-day malperfusion-related complication and mortality rates were determined. Logistic regression model was used to assess preoperative and intraoperative factors affecting postoperative outcomes; in particular, details on the mechanisms of malperfusion and organ(s) involved were entered into the model and tested. Results: A total of 41 patients (60 years old [interquartile range (IQR): 51–68.5]; 78% men) have been included in the analysis. Patients were mostly (68.3%) affected by only 1 malperfusion syndrome, with renal ischemia being the most frequent (53.6%). The median length of aortic coverage was 197 mm (IQR: 157–209). Additional visceral/renal/iliac stentings were performed after stent graft implantation for 25 branches in 17 patients (41%). The 30-day mortality rate was 17.1%. All but 2 early deaths were related to malperfusion. The number of malperfusion syndromes was the only independent factor associated to increasing 30-day malperfusion-related complications or deaths (3 vs 1, HR = 30.3 [P = 0.001]; 3 vs 2, HR = 9.9 [P = 0.004]). Conclusions: Prognosis of patients with acute type B AoD complicated initially with malperfusion syndrome(s) is severe, especially if several territories are ischemic. Early identification of those complications can be lifesaving but still lacks hard criteria.
  •  
46.
  • Sobocinski, Jonathan, et al. (författare)
  • Thoracic endovascular aortic repair with stent grafts alone or with a composite device design in patients with acute type B aortic dissection in the setting of malperfusion
  • 2020
  • Ingår i: Journal of Vascular Surgery. - : Elsevier BV. - 0741-5214. ; 71:2, s. 2-407
  • Tidskriftsartikel (refereegranskat)abstract
    • Objective: The objective of this study was to compare short-term outcomes in patients who underwent thoracic endovascular aortic repair (TEVAR) with stent grafts alone or with a composite device design (stent graft plus bare-metal aortic stent) for acute type B aortic dissection in the setting of malperfusion. Methods: This retrospective analysis included patients with acute (≤14 days of symptom onset) complicated type B dissection in the setting of malperfusion who were treated with stent grafts alone (TEVAR cohort) at two European institutions vs those who underwent TEVAR with a composite device design (Cook Medical, Bloomington, Ind) in the investigational STABLE I feasibility study and STABLE II pivotal study (STABLE cohort). Preoperative characteristics and 30-day outcomes (including mortality, malperfusion-related mortality, morbidity, and secondary interventions) were compared between the two groups. Results: The TEVAR cohort (41 patients; mean age, 58.8 ± 12.7 years; 78.0% male) and the STABLE cohort (84 patients; mean age, 57.8 ± 11.7 years; 71.4% male) were largely similar in preoperative medical characteristics, with more STABLE patients presenting with a history of hypertension (79.8% vs 58.5%; P = .018). The TEVAR and STABLE groups had similar lengths of dissection (451.8 ± 112.7 mm vs 411.8 ± 116.4 mm; P = .10) and similar proximal and distal extent of dissection. At presentation, the two groups exhibited comparable organ system involvement in malperfusion: renal (53.7% TEVAR, 57.1% STABLE), gastrointestinal (41.5% TEVAR, 44.0% STABLE), lower extremities (34.1% TEVAR, 52.4% STABLE), and spinal cord (9.8% TEVAR, 2.4% STABLE). The 30-day rate of all-cause mortality was 17.1% (7/41) in the TEVAR group and 8.3% (7/84) in the STABLE group (P = .22). The 30-day rate of malperfusion-related mortality (deaths from bowel/mesenteric ischemia or multiple organ failure) was 12% (5/41) in the TEVAR group and 2.4% (2/84) in the STABLE group (P = .038). The 30-day morbidity, for the TEVAR and STABLE groups, respectively, included bowel ischemia (9.8% [4/41] vs 2.4% [2/84]; P = .09), renal failure requiring dialysis (7.3% [3/41] vs 9.5% [8/84]; P > .99), paraplegia or paraparesis (4.9% [2/41] vs 3.6% [3/84]; P = .66), and stroke (2.4% [1/41] vs 10.7% [9/84]; P = .16). The occurrence of 30-day secondary intervention was similar in the TEVAR and STABLE groups (7.3% [3/41] vs 7.1% [6/84]; P > .99). True lumen expansion in the abdominal aorta was significantly greater in the STABLE group. Conclusions: In patients with acute type B aortic dissection in the setting of branch vessel malperfusion, the use of a composite device with proximal stent grafts and distal bare aortic stent appeared to result in lower malperfusion-related mortality than the use of stent grafts alone. The 30-day rates of morbidity and secondary interventions were similar between the groups.
  •  
47.
  • Sveinsson, Magnus, et al. (författare)
  • Juxtarenal endovascular therapy with fenestrated and branched stent grafts after previous infrarenal repair
  • 2019
  • Ingår i: Journal of Vascular Surgery. - : MOSBY-ELSEVIER. - 0741-5214 .- 1097-6809. ; 70:6, s. 1747-1753
  • Tidskriftsartikel (refereegranskat)abstract
    • Background: The treatment strategy for proximal aortic disease or type I endoleak after previous infrarenal repair has traditionally been open surgery. As endovascular treatment options with fenestrated and branched stent grafts increasingly rival open surgery for juxtarenal and pararenal aortic aneurysms, secondary proximal repair may similarly be performed endovascularly. Fenestrated stent grafts are individually tailored to each patient, whereas a more readily available "off-the-shelf" branched stent graft is often suitable in more urgent settings. Methods: All patients who had been reoperated on with a proximal fenestrated or branched cuff after previous infrarenal endovascular or open repair from two tertiary referral centers between 2002 and 2015 were included in the analysis. Patients were retrospectively enrolled in a digital database. Data were collected from chart review and digital imaging. Results: There were 43 patients, 37 (86%) male and six (14%) female, who were treated. The indications for proximal endovascular repair were type I endoleak (58%), proximal aneurysm formation (30%), and stent graft migration (12%). Median follow-up time was 33 months (range, 3-120 months); 34 patients (79%) received a fenestrated cuff, and branched stent grafts were used in 8 (19%) cases. The majority of grafts had three (47%) or four (49%) fenestrations or branches. Technical success was accomplished in 93% of cases. In two cases, the celiac trunk occluded; in one case, the hepatic artery was overstented, and a renal artery could not be cannulated in one case. Median hospital stay was 5 days (range, 2-57 days). The 30-day mortality was 0%, and 1-year mortality was 5%. One patient died of an aneurysm-related cause during the study period. Conclusions: An endovascular approach with fenestrated or branched stent grafts for treatment of proximal endoleak, proximal aneurysm formation, or pseudoaneurysms after previous infrarenal repair seems to be a valid alternative to open surgery.
  •  
48.
  • Tsilimparis, Nikolaos, et al. (författare)
  • Transatlantic multicenter study on the use of a modified preloaded delivery system for fenestrated endovascular aortic repair
  • 2023
  • Ingår i: Journal of Vascular Surgery. - 0741-5214. ; 78:4, s. 3-873
  • Tidskriftsartikel (refereegranskat)abstract
    • Objective: Analyze the outcomes of endovascular complex abdominal and thoracoabdominal aortic aneurysm repair using the Cook fenestrated device with the modified preloaded delivery system (MPDS) with a biport handle and preloaded catheters. Methods: A multicenter retrospective single arm cohort study was performed, including all consecutive patients with complex abdominal aortic aneurysm repair and thoracoabdominal aortic aneurysms treated with the MPDS fenestrated device (Cook Medical). Patient clinical characteristics, anatomy, and indications for device use were collected. Outcomes, classified according to the Society for Vascular Surgery reporting standards, were collected at discharge, 30 days, 6 months, and annually thereafter. Results: Overall, 712 patients (median age, 73 years; interquartile range [IQR], 68-78 years; 83% male) from 16 centers in Europe and the United States treated electively were included: 35.4% (n = 252) presented with thoracoabdominal aortic aneurysms and 64.6% (n = 460) with complex abdominal aortic aneurysm repair. Overall, 2755 target vessels were included (mean, 3.9 per patient). Of these, 1628 were incorporated via ipsilateral preloads using the MPDS (1440 accessed from the biport handle and 188 from above). The mean size of the contralateral femoral sheath during target vessel catheterization was 15F ± 4, and in 41 patients (6.7%) the sheath size was ≤8F. Technical success was 96.1%. Median procedural time was 209 minutes (IQR, 161-270 minutes), contrast volume was 100 mL (IQR, 70-150mL), fluoroscopy time was 63.9 minutes (IQR, 49.7-80.4 minutes) and median cumulative air kerma radiation dose was 2630 mGy (IQR, 838-5251 mGy). Thirty-day mortality was 4.8% (n = 34). Access complications occurred in 6.8% (n = 48) and 30-day reintervention in 7% (n = 50; 18 branch related). Follow-up of >30 days was available for 628 patients (88%), with a median follow-up of 19 months (IQR, 8-39 months). Branch-related endoleaks (type Ic/IIIc) were observed in 15 patients (2.6%) and aneurysm growth of >5 mm was observed in 54 (9.5%). Freedom from reintervention at 12 and 24 months was 87.1% (standard error [SE],1.5%) and 79.2% (SE, 2.0%), respectively. Overall target vessel patency at 12 and 24 months was 98.6% (SE, 0.3%) and 96.8% (SE, 0.4%), respectively, and was 97.9% (SE, 0.4%) and 95.3% (SE, 0.8%) for arteries stented from below using the MPDS, respectively. Conclusions: The MPDS is safe and effective. Overall benefits include a decrease in contralateral sheath size in the treatment of complex anatomies with favorable results.
  •  
49.
  •  
50.
  • Vaccarino, Roberta, et al. (författare)
  • Ilio-femoral calcium score may assist Glasgow Aneurysm Score prediction of long-term survival of low-risk patients after infrarenal EVAR
  • 2022
  • Ingår i: International Angiology. - 1827-1839. ; 41:4, s. 285-291
  • Tidskriftsartikel (refereegranskat)abstract
    • BACKGROUND: The aim of this study is to evaluate if ilio-femoral calcium score (CS) combined with Glasgow Aneurysm Score (GAS) can improve the prediction of long-term survival after EVAR.METHODS: All the patients who underwent infrarenal endovascular aortic repair (EVAR) for non-ruptured AAA between January 2004 and December 2012 at a tertiary referral center were retrospectively included if the preoperative imaging was of sufficient quality and they had survived for more than 30 days. Preoperative non-contrast enhanced CT were used to measure ilio-femoral calcium score using dedicated postprocessing software. GAS was calculated and patients were divided into low or high GAS by a cutoff of 80.RESULTS: Two hundred and eighty-eight out of 500 patients were included in the study with no difference in survival compared to excluded patients (P=0.529). Patients were followed-up for a median of 7 (range 4-9) years. GAS correlated positively with ilio-femoral calcium score (r=0.123; P=0.037). One hundred and thirty-five patients (46.9%) had low GAS, and 153 (53.1%) had high GAS. Patients with high GAS had lower survival compared to the ones with low GAS (P≤0.0001). GAS was associated with long-term mortality in a uni- and multivariate regression (P≤0.0001 and P≤0.0001). Ilio-femoral calcium score was significantly associated with mortality in the group with low GAS (P=0.028), but not in the group with high GAS (P=0.297). Significance retained in multivariate regression analysis (P=0.029). Moreover, in the low GAS group, ilio-femoral calcium score was further divided in high and low according to the median. Patients with high calcium score had lower survival compared to the ones with low calcium score (P=0.047).CONCLUSIONS: Long-term survival in patients who have had infrarenal EVAR can be predicted by the clinically based Glasgow Aneurysm Score. Measuring the ilio-femoral calcium score preoperatively may refine GAS assessment in low-risk patients.
  •  
Skapa referenser, mejla, bekava och länka
  • Resultat 1-50 av 53
Typ av publikation
tidskriftsartikel (49)
forskningsöversikt (2)
konferensbidrag (1)
bokkapitel (1)
Typ av innehåll
refereegranskat (51)
övrigt vetenskapligt/konstnärligt (2)
Författare/redaktör
Resch, Timothy (38)
Sonesson, Björn (24)
Malina, Martin (18)
Dias, Nuno (16)
Dias, Nuno V. (11)
Ivancev, Krassi (11)
visa fler...
Kristmundsson, Thora ... (9)
Wanhainen, Anders (7)
Björck, Martin (5)
Acosta, Stefan (5)
Lindblad, Bengt (5)
Sobocinski, Jonathan (5)
Haulon, Stephan (4)
Kölbel, Tilo (4)
Mani, Kevin, 1975- (4)
Antoniou, George A. (4)
Coscas, Raphaël (4)
Mees, Barend M.E. (4)
Trimarchi, Santi (4)
Tulamo, Riikka (4)
Björses, Katarina (4)
Dick, Florian (3)
Resch, Tim (3)
Gottsäter, Anders (3)
Björnsson, Steinarr (3)
Twine, Christopher P (3)
Chakfé, Nabil (3)
Kakkos, Stavros K. (3)
Tsilimparis, Nikolao ... (3)
Fransson, Torbjörn (3)
Adam, Donald (2)
Gargiulo, Mauro (2)
Abdulrasak, Mohammed (2)
Kolh, Philippe (2)
De Borst, Gert J (2)
Block, Tomas (2)
Nordanstig, Joakim (2)
Edsfeldt, Andreas (2)
Holst, Jan (2)
Behrendt, Christian- ... (2)
Bastos Gonçalves, Fr ... (2)
Leone, Nicola (2)
Goncalves, Frederico ... (2)
Lindholt, Jes S (2)
Montan, Carl (2)
Isernia, Giacomo (2)
Bellmunt-Montoya, Se ... (2)
Fitridge, Robert (2)
Baumgartner, Iris (2)
Hinchliffe, Robert J ... (2)
visa färre...
Lärosäte
Lunds universitet (44)
Uppsala universitet (11)
Umeå universitet (3)
Linköpings universitet (3)
Karolinska Institutet (3)
Göteborgs universitet (2)
visa fler...
Örebro universitet (2)
visa färre...
Språk
Engelska (52)
Svenska (1)
Forskningsämne (UKÄ/SCB)
Medicin och hälsovetenskap (53)

År

Kungliga biblioteket hanterar dina personuppgifter i enlighet med EU:s dataskyddsförordning (2018), GDPR. Läs mer om hur det funkar här.
Så här hanterar KB dina uppgifter vid användning av denna tjänst.

 
pil uppåt Stäng

Kopiera och spara länken för att återkomma till aktuell vy