| 1. |
- Fattahi, Nina, et al.
(författare)
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Prevalence of abdominal aortic aneurysm (AAA) in first-degree relatives : detecting AAA in adult offspring of AAA patients
- 2024
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Ingår i: BJS Open. - : Oxford University Press. - 2474-9842. ; 8:1
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Tidskriftsartikel (refereegranskat)abstract
- BackgroundFirst-degree relatives of patients with abdominal aortic aneurysm (AAA) may have an increased risk of developing the disease. The primary aim was to report the prevalence of AAA in adult male and female offspring of patients with AAA. The secondary aim was to explore the efficiency of a registry-based detection route, and the third aim was to report contemporary prevalence in the population.MethodsAdult offspring of individuals with AAA and matched controls were identified through national registries. The examination included questionnaires and ultrasound examinations of the infrarenal aorta. Aortic pathology was defined as an aortic diameter ≥25 mm, AAA ≥30 mm.ResultsThe participation rate among male and female adult offspring was 64% (350/543) and 69% (402/583), respectively. A lower participation rate was found in male and female controls (51% and 52%). No difference in prevalence of AAA was observed between male adult offspring and controls (0.9%, c.i. 0.2 to 2.3%) or in the female population (prevalence of 0.2% in adult offspring and controls). Aortic pathology and previously diagnosed AAA were detected in 5.3% (c.i. 3.3 to 8.0%) of male adult offspring and 2.3% (c.i. 1.1 to 4.2%) in controls. Aortic pathology was more prevalent among adult offspring of females with AAA.ConclusionThe prevalence of AAA in the general population is low, but aortic pathology is notably higher among male first-degree relatives. Increased awareness should be directed towards individuals with a possible hereditary predisposition, particularly offspring of females with AAA and older smokers. Risk factor-based targeted screening of adult offspring of patients with AAA after registry-based detection should be further explored.
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| 2. |
- Hultgren, R., et al.
(författare)
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Cost-effectiveness of targeted screening for abdominal aortic aneurysm in siblings
- 2019
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Ingår i: British Journal of Surgery. - : Oxford University Press (OUP). - 0007-1323 .- 1365-2168. ; 106:3, s. 206-216
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Tidskriftsartikel (refereegranskat)abstract
- Background: Population screening for abdominal aortic aneurysm (AAA) in 65‐year‐old men has been shown to be cost‐effective. A risk group with higher prevalence is siblings of patients with an AAA. This health economic model‐based study evaluated the potential cost‐effectiveness of targeted AAA screening of siblings.Methods: A Markov model validated against other screening programmes was used. Two methods of identifying siblings were analysed: direct questioning of patients with an AAA (method A), and employing a national multigeneration register (method B). The prevalence was based on observed ultrasound data on AAAs in siblings. Additional parameters were extracted from RCTs, vascular registers, literature and ongoing screening. The outcome was cost‐effectiveness, probability of cost‐effectiveness at different willingness‐to‐pay (WTP) thresholds, reduction in AAA death, quality‐adjusted life‐years (QALYs) gained and total costs on a national scale.Results_ Methods A and B were estimated to reduce mortality from AAA, at incremental cost‐effectiveness ratios of €7800 (95 per cent c.i. 4627 to 12 982) and €7666 (5000 to 13 373) per QALY respectively. The probability of cost‐effectiveness was 99 per cent at a WTP of €23 000. The absolute risk reduction in AAA deaths was five per 1000 invited. QALYs gained were 27 per 1000 invited. In a population of ten million, methods A and B were estimated to prevent 12 and 17 AAA deaths, among 2418 and 3572 siblings identified annually, at total costs of €499 500 and €728 700 respectively.Conclusion: The analysis indicates that aneurysm‐related mortality could be decreased cost‐effectively by applying a targeted screening method for siblings of patients with an AAA.
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| 3. |
- Hultgren, Rebecka, et al.
(författare)
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Evaluating feasibility of using national registries for identification, invitation, and ultrasound examination of persons with hereditary risk for aneurysm disease-detecting abdominal aortic aneurysms in first degree relatives (adult offspring) to AAA patients (DAAAD)
- 2022
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Ingår i: Pilot and Feasibility Studies. - : BioMed Central (BMC). - 2055-5784. ; 8:1
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Tidskriftsartikel (refereegranskat)abstract
- BackgroundSweden and the UK invite all 65-year-old men to a population-based ultrasound-based screening program to detect abdominal aortic aneurysms (AAA). First-degree relatives of patients with AAA are reported to have an increased risk to develop AAA, both women and men, but are not invited to screening. The "Detecting AAA in First Degree Relatives to AAA patients " (DAAAD) was designed to detect the true prevalence in adult offspring to AAA patients and to evaluate if national registries could be used for identification of index persons and their adult children with a high risk for the disease. The aim of this study is to summarize the design and methodology for this registry-based study. MethodsThe study is based on a registry-based extraction and identification of a risk group in the population with a subsequent identification of their adult offspring. The targeted risk group suffers a heredity for a potentially lethal disease, AAA (n = 750) and matched control group without heredity for AAA is also identified and invited (n = 750). The participation rate in the population-based AAA screening program for men is 75% regionally. This population is younger and have a lower prevalence. A participation rate of 65% is considered clinically adequate. For the DAAAD study, a stratified analysis of the primary outcome, prevalence, will be performed for women and men separately. Two other planned projects are based on the material: firstly, evaluation of the anxiety for disease and health-related quality of life (HRQoL) and, secondly, the cost-effectiveness of the study. DiscussionIn conclusion, this feasibility study will be instrumental in supporting the development of a possible new model to invite persons with high risk to develop hereditary rare diseases. To our knowledge, this is a unique, safe, and most likely to be a cost-efficient model to invite targeted risk groups for selected screening. If the study design and the results are shown to be cost-effective at the detected participation rate and prevalence, it should be further evaluated and adopted to a national screening program. The model also invites both women and men, which is unique for this specific patient group, considering that all population-based screening programs only include men.
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| 4. |
- Högberg, Dominika, et al.
(författare)
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Clinical effect and cost effectiveness of screening for asymptomatic carotid stenosis : A Markov model
- 2018
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Ingår i: European Journal of Vascular and Endovascular Surgery. - : Elsevier BV. - 1078-5884 .- 1532-2165. ; 55:6, s. 819-827
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: Screening for asymptomatic carotid artery stenosis (ACAS) is controversial. The cost-effectiveness of screening depends on screening cost, ACAS prevalence, and the potential stroke reducing effect of best medical treatment (BMT). The aim of the study was to determine the threshold values for these parameters in order for screening for ACAS to be cost-effective. Material and methods: The clinical effect and cost-effectiveness of ultrasound-screening for ACAS with subsequent initiation of BMT versus not screening, was assessed in a Markov model with a life-time perspective. Key parameters; including stroke risk, all-cause mortality, and costs were based on contemporary published data, population statistics and ongoing screening programs. Prevalence of ACAS and rate of ongoing BMT was based on data from a population recently screened for ACAS. Minimum required stroke-risk reduction from BMT, incremental cost-efficiency ratio (ICER), absolute risk reduction for stroke (ARR), number needed to screen (NNS) were calculated. Results: Screening was cost-effective at an ICER of €5744 per incremental quality adjusted life-year (QALY) gained. ARR was 135 per 100000 screened, NNS was 741 and QALYs gained were 6700 per 100000 invited. At a willingness-to-pay (WTP) threshold of €50,000 per QALY the minimum required stroke risk reduction from BMT was 22%. The assumed degree of stroke risk reduction was the most important determinant of cost-efficiency. Conclusion: A moderate (22%) reduction in the risk of stroke from BMT was required for an ACAS screening strategy to be cost-effective at WTP of €50,000/QALY. Targeting populations with higher prevalence of ACAS could improve cost-efficiency.
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| 5. |
- Högberg, Dominika, et al.
(författare)
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Five-year outcomes in men screened for carotid artery stenosis at 65 years of age : a population-based cohort study
- 2019
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Ingår i: European Journal of Vascular and Endovascular Surgery. - : Elsevier BV. - 1078-5884 .- 1532-2165. ; 57:6, s. 759-766
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: The aim was to determine the prognosis of 65-year old men five years after carotid ultrasound screening, as well as risk factors for disease progression.Material and methods: All 65-year-old men living in the county of Uppsala 2007-2009 were invited to an ultrasound examination of both carotid arteries and re-invited at age 70. The cohort was grouped into: normal carotids, plaque without significant stenosis, moderate stenosis (50-79%), and severe stenosis (80-99%). The rates of disease progression to death, significant stenosis, and neurological events were assessed, as well as risk factors and medication.Results: Among men participating in carotid screening at age 65, 3057 were re-screened at age 70. In those with normal carotids (n=2318), 23 (1.0%) progressed to a moderate, and four (0.2%) developed a symptomatic severe stenosis. Among those with plaque (n=696), 25 (3.6%) progressed to moderate, and eight (1.1%) to severe stenosis, of whom four (0.6%) had symptoms. Of 31 with 50-79% stenosis, four (12.9%) had progressed to a severe stenosis, of whom two (6.5%) developed symptoms. Five of twelve subjects (42%) with 80-99% stenosis developed symptoms. Disease regression was present among 306 (41.4%) men. In multivariable analysis, smoking, coronary artery disease and hypercholesterolemia were associated with disease progression. The proportions of antiplatelet, statin and antihypertensive treatment in the population at age 70 were 22%, 29% and 55% respectively.Conclusion: Men with plaques and moderate stenosis have a good prognosis, but in those with severe stenosis there was a high risk of neurological events.
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| 6. |
- Lyttkens, Linda
(författare)
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Health Related Quality of Life in patients with screening detected Sub-Aneurysmal aorta and Abdominal Aortic Aneurysm
- 2023
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Licentiatavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Objective Paper I: Most screening and opportunistically detected abdominal aortic aneurysms (AAA) are small and kept under surveillance for several years before preventive surgery. Living with the diagnosis of an AAA may have an influence on the patient’s life. The aim was to review systematically review the current knowledge of the effect on health related quality of life (HRQoL) and patients’ experiences of living with an AAA while under surveillance.Paper II: To investigate HRQoL and comorbidity in men with screening detected AAA, Sub-Aneurysmal aorta (SAA) and Controls at baseline screening and after long-term follow-up.Methods Paper I: A systematic literature review of quantitative and qualitative studies, which were quality assessed according to the GRADE system, was carried out. PubMed, Cochrane, Embase, CINAHL, PsycINFO, and MEDLINE were searched. Narrative synthesis and meta-analysis were performed and reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement.Paper II: Between 2006 and 2015, 16 689 sixty-five-year old men participated in the aortic screening program in the county of Uppsala in Sweden. All 539 men diagnosed with an SAA or AAA were invited to participate in the study UpAAA and 324 accepted. Baseline questionnaires was distributed after screening, and at 5-year follow-up. For each year a control group of approx. 50 men, participating in the screening program with normal aorta, were included. ResultsPaper I: Synthesis and meta-analyses of studies based on the Short Form-36 demonstrated that patients with an AAA consistently rated their general health lower than controls and conveyed no significant negative impact for patients with an AAA when assessed at follow up and compared with pre-screening. Analysis of HRQoL estimates of mental health, anxiety, and depression demonstrated no significant differences for patients with AAA compared with controls, or within the AAA group. Qualitative studies revealed that patients with an AAA felt safe being under surveillance and receiving a diagnosis of AAA set thoughts and feelings in motion regarding health, ageing, and mortality. Patients’ lack of knowledge about the disease, its progression, and future planning can cause insecurity and worries.Paper II: AAA and SAA group both has impairment in the physical dimensions of HRQOL and a higher prevalence of co-morbidity at baseline, compared to controls. At 5-year follow-up, the similarities between AAA and SAA group remained with no difference in HRQOL but a higher prevalence of CVD, hypertension and diabetes in men with AAA. Compared with controls both AAA and SAA had significantly higher impairment in HRQoL, and prevalence of co-morbidity and the AAA group was most affected.
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| 7. |
- Lyttkens, Linda, et al.
(författare)
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Long-term Health Related Quality of Life in men with screening detected abdominal aortic aneurysm: A five-year follow-up study.
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Annan publikation (övrigt vetenskapligt/konstnärligt)abstract
- Objective: To investigate how HRQoL and comorbidity differs in men with screening detected abdominal aortic aneurysm (AAA), sub-aneurysmal aorta (SAA) and controls screened with a normal aorta, measured after baseline screening and at five-year follow-up.Methods: Between 2006 and 2015, 19 738 65-year old men were invited and 16 689 participated in the AAA screening program in the county of Uppsala in Sweden. All 539 men diagnosed with an SAA or AAA were invited to participate in the study, of whom 324 accepted. HRQoL (RAND-36) and health questionnaires was distributed approximately two weeks after screening, and at 5-year follow-up. For each year a control group of approx. 50 men with normal aortic diameter at screening were included. Results: Compared with controls, AAA and SAA patients reported significantly lower scores in the dimensions Physical Function (Mean 90.6 vs 84.8 p=0.005 and 81.3 p=0.002), General Health (76.7 vs 71.0 p=0.005 and 67.5 p<0.001), and Vitality (78.2 vs 73.2 p=0.049 and 69.6 p=0.003) with a corresponding higher prevalence of co-morbidity at baseline. After 5 years of follow-up, SAA and AAA patients showed a further reduction in HRQoL scores in several dimensions. Despite a significantly higher comorbidity burden among AAA patients (vs SAA), the numerical difference in HRQoL between the two groups was not significant. Conclusion: AAA and SAA patients are burdened with a higher degree of comorbidity and an associated impaired HRQoL at baseline screening, with a further deterioration during long-term follow-up up to 5 years, with an associated deterioration in health.
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| 8. |
- Lyttkens, Linda, et al.
(författare)
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Systematic Review and Meta-Analysis of Health Related Quality of Life and Reported Experiences in Patients With Abdominal Aortic Aneurysm Under Ultrasound Surveillance
- 2020
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Ingår i: European Journal of Vascular and Endovascular Surgery. - : Elsevier BV. - 1078-5884 .- 1532-2165. ; 59:3, s. 420-427
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Forskningsöversikt (refereegranskat)abstract
- Objective: Most screening and opportunistically detected abdominal aortic aneurysms (AAA) are small and kept under surveillance for several years before preventive surgery. Living with the diagnosis of an AAA may have an influence on the patient's life. Thus, it is important to study patients' experiences so that the screening process and follow up care are adapted to the patient's needs. The aim was to review systematically review the current knowledge of the effect on health related quality of life (HRQoL) and patients' experiences of living with an AAA while under surveillance.Methods: A systematic literature review of quantitative and qualitative studies, which were quality assessed according to the GRADE system, was carried out. Pubmed, Cochrane, Embase, CINAHL, PsycINFO, and MEDLINE were searched. Narrative synthesis and meta-analysis were performed and reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement.Results: Synthesis and meta-analyses of studies based on the Short Form-36 demonstrated that patients with an AAA consistently rated their general health (GH) lower than controls and conveyed no significant negative impact for patients with an AAA when assessed at follow up and compared with pre-screening. Synthesis and meta-analyses of HRQoL estimates encompassing mental health, anxiety, and depression demonstrated no significant differences for patients with AAA compared with controls, or within the AAA group. Qualitative studies revealed that patients with an AAA felt safe being under surveillance, and receiving a diagnosis of AAA set thoughts and feelings in motion regarding health, ageing, and mortality. Patients' lack of knowledge about the disease, its progression, and future planning can cause insecurity and worries.Conclusion: The current evidence does not support a negative impact on HRQoL from being under surveillance for an AAA. Qualitative data indicate that adequate patient information and professional care have the potential to reduce unnecessary worries and concerns in patients with an AAA.
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| 9. |
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| 10. |
- Svensjö, Sverker, 1968-
(författare)
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Abdominal Aortic Aneurysm Screening in Sweden
- 2014
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Ingår i: Gefässchirurgie. - : Springer Berlin/Heidelberg. - 0948-7034 .- 1434-3932. ; 19:6, s. 540-544
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Tidskriftsartikel (refereegranskat)abstract
- A large body of evidence from four international randomised controlled trials (RCT) on abdominal aortic aneurysm (AAA) screening indicate that ultrasound-based screening in elderly men with a high prevalence (4 %–7 %) reduces AAA-related mortality by 40 % through early AAA detection and increased preventive elective repair and subsequently halves rupture incidence. Coinciding with the planned launch of national AAA screening programs, a dramatic change in AAA epidemiology became evident: a lower AAA prevalence in the targeted population of men and falling mortality rates, most likely related to a drop in rates of smoking, and a paradoxical increase in elective AAA repairs. These changes have called AAA screening in today’s context into question. Sweden was the first country to provide national coverage with an AAA screening program targeting 65-year-old men. The scientifically evaluated screening initiative, started in 2006, reported the lower than expected prevalence (1.7 %) in 65-year-old men early on. Cost-effectiveness seems to be maintained despite the altered epidemiology, as shown in a health-economic study. The current prevalence of AAA among Swedish women is very low, and general population-based screening of women is likely to be futile, although targeted screening among female smokers should be evaluated. Sub-aneurysmal aortas detected at screening are likely to progress to a true AAA within 5 years, indicating a need for continued surveillance in this group. Differences in screening compliance seem to be linked to socio-economic factors. The aim of this topical review is to highlight AAA screening within a Swedish context and point to areas where information is lacking and further research is needed.
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| 11. |
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| 12. |
- Svensjö, Sverker, 1968-, et al.
(författare)
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Screening for Abdominal Aortic Aneurysm in 65-Year-old Men Remains Cost-effective with Contemporary Epidemiology and Management
- 2014
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Ingår i: European Journal of Vascular and Endovascular Surgery. - : Elsevier BV. - 1078-5884 .- 1532-2165. ; 47:4, s. 357-365
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Tidskriftsartikel (refereegranskat)abstract
- ObjectivesThe epidemiology and management of abdominal aortic aneurysms (AAA) has changed significantly, with lower prevalence, increased longevity of patients, increased use of endovascular aneurysm repair (EVAR), and improved outcome. The clinical and health economic effectiveness of one-time screening of 65-year-old men was assessed within this context.MethodsOne-time ultrasound screening of 65-year-old men (invited) versus no screening (control) was analysed in a Markov model. Data on the natural course of AAA (risk of repair and rupture) was based on randomised controlled trials. Screening detected AAA prevalence (1.7%), surgical management (50% EVAR), repair outcome, costs, and long-term survival were based on contemporary population-based data. Incremental cost-efficiency ratios (ICER), absolute and relative risk reduction for death from AAA (ARR, RRR), numbers needed to screen (NNS), and life-years gained were calculated. Annual discounting was 3.5%.ResultsIn base case at 13-years follow-up the ICER was €14,706 per incremental quality-adjusted life-year (QALY); ARR was 15.1 per 10,000 invited, NNS was 530, and QALYs gained were 56.5 per 10,000 invited. RRR was 42% (from 0.36% in control to 0.21% in invited). In a lifetime analysis the ICER of screening decreased to €7,570/QALY. The parameters with highest impact on the cost-efficiency of screening in the sensitivity analysis were the prevalence of AAA (threshold value <0.5%) and degree of incidental detection in the control cohort.ConclusionsIn the face of recent changes in the management and epidemiology of AAA, screening men for AAA remains cost-effective and delivers significant clinical impact.
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| 13. |
- Söderberg, Patrik, et al.
(författare)
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Five Year Natural History of Screening Detected Sub-Aneurysms and Abdominal Aortic Aneurysms in 70 Year Old Women and Systematic Review of Repair Rate in Women
- 2017
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Ingår i: European Journal of Vascular and Endovascular Surgery. - : Elsevier BV. - 1078-5884 .- 1532-2165. ; 53:6, s. 802-809
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Tidskriftsartikel (refereegranskat)abstract
- Objective: The aim of this study was to report on the natural history of a population based cohort of 70 year old women with screening detected dilated aortas, and to systematically review publications reporting the rate of intact infrarenal aneurysm repair in women.Material and methods: In a previous study, 5140 (74%) of 6925 invited women attended an ultrasound (US) examination of the abdominal aorta at age 70 years. All 52 women with screening detected sub-aneurysms (SA, diameter 25-29 mm) and abdominal aortic aneurysms (AAA, diameter >= 30 mm), were followed for 5 years with US. Infrarenal aortic diameters, AAA repair, all-cause and AAA specific mortality, and risk factors were recorded. In addition, a systematic review was conducted of the rate of intact infrarenal aneurysm repair in women.Results: A total of 33 (0.6%) women had a SA at the age of 70; two (6%) declined follow-up, five (15%) had died, and 26 were re-examined after 5 years follow-up at age 75. Twelve of 26 (46%) had progressed to AAAs, where one was directly qualified for surgery. Smoking (p = .010) and aortic diameter (p = .040) were associated with progression to AAA. A total of 19 (0.4%) women had an AAA at age 70; two (11%) had died, six (32%) had been electively repaired with no 30 day mortality, and 11 (58%) had an AAA still under surveillance after 5 years follow-up at age 75 years. In the systematic search four studies with heterogeneous cohorts were identified and data on natural history were extracted and reviewed.Conclusion: Screening detected AAAs and sub-aneurysms are clinically relevant in women. Within 5 years of detection a high proportion of AAAs require elective surgery, and a high proportion of sub-aneurysms progress to AAAs. Consequently, surveillance of sub-aneurysms in women with reasonable life expectancy can be considered. Publications on repair rate in women with intact AAAs are scarce and heterogeneous.
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| 14. |
- Thorbjørnsen, Knut
(författare)
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Aspects of subaneurysmal aortas in a screening setting
- 2023
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- With the introduction of screening programmes for abdominal aortic aneurysm (AAA) more individuals are being identified with a subaneurymal aorta (SAA; diameter 25-29mm). More recent data indicate that these aortas may not be as harmless as previously thought, but there is, however, no general agreement on how SAA should be managed.The aims of this thesis were to study men with screening detected SAA, regarding: (I) prevalence, risk factors and comorbidities; (II), the long-term natural course regarding development to AAA ≥30mm, in particular the progression to AAA ≥55mm, to assess the AAA repair rate, turn down, and mortality rates; (III) the association between aortic morphological baseline factors; (SAA diameter, aortic index related to height and body surface area as well as relative aortic diameter to proximal aorta) and the risk for later progression to AAA ≥55mm; and (IV) describe health utility (HU) values and compare them in men with screened AAA, SAA and in men with normal aortic diameters.There was a marked similarity in the risk factor profile between men with SAA representing 2% of the screening population and men with AAA with smoking as the most important risk factor, with an incremental association between smoking and disease severity. Most SAAs eventually progress to an AAA ≥30mm, of which 30% eventually reach the threshold for AAA-repair within 10 years. A follow-up policy with an ultrasound scan after five years can safe and effectively identify those at risk of developing clinically relevant AAAs, and should be considered for anyone with reasonably good life expectancy. Baseline SAA diameter, aortic size index, and aortic height index were all independently associated with progression to AAA ≥55mm, with aortic size index as the strongest predictor, whereas relative aortic diameter was not. These morphological factors may be considered for stratification of follow-up at initial screening. At baseline screening, HUs were similar between men with AAA, SAA, and normal aortas. Compared to SAAs and controls, lower health utility scores were observed in men with AAA after five years, most likely associated with higher frequency of smoking and comorbidities.
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| 15. |
- Thorbjörnsen, Knut, et al.
(författare)
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Long Term Outcome of Screen Detected Sub-Aneurysmal Aortas in 65 Year Old Men : a Single Scan After Five Years Identifies Those at Risk of Needing AAA Repair
- 2021
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Ingår i: European Journal of Vascular and Endovascular Surgery. - : Elsevier. - 1078-5884 .- 1532-2165. ; 62:3, s. 380-386
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Tidskriftsartikel (refereegranskat)abstract
- Objective: The epidemiology of sub-aneurysmal aortic dilatation (SAA) 25 - 29 mm is not fully understood, and the management of SAA is debated. Lack of evidence is particularly problematic in the screening setting. This study aimed to evaluate the long term outcome of men with screen detected SAAs, focusing on progression to an abdominal aortic aneurysm (AAA), and on the AAAs reaching the threshold diameter for surgical repair. Methods: Between 2006 and 2015, all 65 year old men with a screen detected SAA in middle Sweden were re-examined with ultrasound after five and 10 years. The primary outcomes were expansion to AAA >= 30 mm and progression to AAA >= 55 mm. Secondary outcomes were risk factors for progression, repair rate, and mortality. Results: A total of 1 020 65 year old men with a SAA were identified, of whom 940 (92.2%; 95% confidence interval 91.0 - 93.8) had follow up. The Kaplan-Meier estimated incidence of AAA >= 30 mm development after the five year follow up (which was de facto carried out after a mean of 4.9 years) was 65.8% (61.6 - 69.4), all < 55 mm. The corresponding KM-estimated incidence after the 10 year follow up (carried out after a mean of 11.9 years) was 95.1% (90.1 - 97.4), and 29.7% (18.0 - 39.7) reached >= 55 mm. All 41 SAAs eventually expanding to >= 55 mm were >= 30 mm at the five year follow up. Of these, 32 had surgical repair with 100% survival, six have scheduled repairs, and three (7.3%) were unfit for repair. The KM estimated all cause mortality rates at five and 10 years were 7.0% and 17.9%, respectively, with no proven AAA related deaths. Conclusion: A majority of SAAs eventually progress to an AAA, of which 30% are estimated to eventually reach the threshold for repair within 10 years. A follow up policy with an ultrasound examination after five years can safely and effectively identify those SAAs at risk of developing into clinically significant AAAs needing repair and may be considered for anyone with reasonably good life expectancy.
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| 16. |
- Thorbjørnsen, Knut, et al.
(författare)
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Morphological factors associated with progression of subaneurysmal aortas
- 2023
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Ingår i: British Journal of Surgery. - : Oxford University Press. - 0007-1323 .- 1365-2168. ; 110:4, s. 489-497
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Tidskriftsartikel (refereegranskat)abstract
- Background: The aim of this population-based cohort study was to assess the association between aortic morphological baseline factors in 65-year-old men with subaneurysmal aortic diameter (25–29 mm) and risk of later progression to abdominal aortic aneurysm (AAA) generally considered to be at a diameter for repair (at least 55 mm).Methods: Men with a screening-detected subaneurysmal aorta between 2006 and 2015 in mid-Sweden were re-examined using ultrasonography after 5 and 10 years. Cut-off values for baseline subaneurysmal aortic diameter, aortic size index, aortic height index, and relative aortic diameter (with respect to proximal aorta) were analysed using receiver operating characteristic (ROC) curves, and their associations with progression to AAA diameter at least 55 mm evaluated by means of Kaplan–Meier curves and a multivariable Cox proportional hazard analysis adjusted for traditional risk factors.Results: Some 941 men with a subaneurysmal aorta and median follow-up of 6.6 years were identified. The cumulative incidence of AAA diameter at least 55 mm at 10.5 years was 28.5 per cent for an aortic size index of 13.0 mm/m2 or more (representing 45.2 per cent of the population) versus 1.1 per cent for an aortic size index of less than 13.0 mm/m2 (HR 9.1, 95 per cent c.i. 3.62 to 22.85); 25.8 per cent for an aortic height index of at least 14.6 mm/m (58.0 per cent of the population) versus 2.0 per cent for an aortic height index of less than 14.6 mm/m (HR 5.2, 2.23 to 12.12); and 20.7 per cent for subaneurysmal aortic diameter 26 mm or greater (73.6 per cent of the population) versus 1.0 per cent for a diameter of less than 26 mm (HR 5.9, 1.84 to 18.95). Relative aortic diameter quotient (HR 1.2, 0.54 to 2.63) and difference (HR 1.3, 0.57 to 3.12) showed no association with development of AAA of 55 mm or greater.Conclusion: Baseline subaneurysmal aortic diameter, aortic size index, and aortic height index were all independently associated with progression to AAA at least 55 mm, with aortic size index as the strongest predictor, whereas relative aortic diameter was not. These morphological factors may be considered for stratification of follow-up at initial screening.
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| 17. |
- Thorbjörnsen, Knut, et al.
(författare)
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Prevalence and natural history of and risk factors for subaneurysmal aorta among 65-year-old men
- 2019
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Ingår i: Upsala Journal of Medical Sciences. - : TAYLOR & FRANCIS LTD. - 0300-9734 .- 2000-1967. ; 124:3, s. 180-186
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Tidskriftsartikel (refereegranskat)abstract
- Background: The aims of this study were to determine the prevalence of screening-detected subaneurysmal aorta (SAA), i.e. an aortic diameter of 2.5-2.9 cm, its associated risk factors, and natural history among 65-year-old men.Methods: A total of 14,620 men had their abdominal aortas screened with ultrasound and completed a health questionnaire containing information on smoking habits and medical history. They were categorized based on the aortic diameter: normal aorta (n = 14,129), SAA (2.5-2.9 cm; n = 258), and abdominal aortic aneurysm (AAA) (>= 3.0 cm; n = 233). The SAA-group was rescanned after 5 years. Associated risk factors were analyzed.Results: The SAA-prevalence was 1.9% (95% confidence interval 1.7%-2.1%), with 57.0% (50.7%-63.3%) expanding to >= 3.0 cm within 5 years. Frequency of smoking, coronary artery disease, hypertension, hyperlipidemia, and claudication were significantly higher in those with SAA and AAA compared to those with normal aortic diameter. Current smoking was the strongest risk factor for SAA (odds ratio [OR] 2.8; P < 0.001) and even stronger for AAA (OR 3.6; P < 0.001). Men with SAA expanding to AAA within 5 years presented pronounced similarities to AAA at baseline.Conclusions: Men with SAA and AAA presented marked similarities in the risk factor profile. Smoking was the strongest risk factor with an incremental association with disease severity, and disease progression. This indicates that SAA and AAA may have the same pathophysiological origin and that SAA should be considered as an early stage of aneurysm formation. Further research on the cost-effectiveness and potential benefits of surveillance as well as smoking cessation and secondary cardiovascular prevention in this subgroup is warranted.
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| 18. |
- Thorbjørnsen, Knut, et al.
(författare)
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Quality-adjusted life years in 65-year-old men screened for abdominal aortic aneurysm : a five-year follow-up study
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Annan publikation (övrigt vetenskapligt/konstnärligt)abstract
- Background: The objective of the present study was to assess population and disease-specific health utility (HU) values in men screened for abdominal aortic aneurysm (AAA) in a population-based screening program.Methods: A total of 110 men with AAA at least 30mm, 148 with subaneurysmal aorta (SAA; 25-29mm), and 123 controls (<25mm) with normal aortic diameter reported their health- related quality of life (HRQoL) utilising the EQ-5D-3L instrument, at baseline screening and after five years. HU was calculated according to a Swedish experience-based value set. Mean HU between the groups and within each group were compared. Also men undergoing AAA repair and those still under surveillance were compared after 5 years. To adjust for confounding factors (smoking and comorbidity) a regression model was used.Results: At baseline screening the mean HUs did not differ between controls: 0.94 (standard deviation (SD);0.06), and AAA: 0.92 (SD; 0.07, P=0.114), and SAA: 0.93 (SD;0.06, P=0.509). After 5 year follow-up no difference was observed between controls: 0.93 (SD;0.06) and SAA: 0.91 (SD;0.08, P=0.183), while men with AAA reported a significantly lower mean HU value: 0.90 (SD;0.09) than the control group (P=0.049). After adjustment for differences in smoking and comorbidities this significance was, howerver lost (P=0.759). No significant differences in mean HU values were seen between men with a screening detected AAA undergoing surgery within 5-years; 0.90 (SD;0.08) and men with small AAAs still under surveillance; 0.90 (SD; 0.09), P=0.757).Conclusion: Compared to SAA and controls, lower health utility scores were observed in men with AAA after five years, most likely explained by the observed higher frequency of smoking and other comorbidities among men with AAA. These contemorary HU values can serve as important components in up-coming health-economic evaluations.
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| 19. |
- Wanhainen, Anders, et al.
(författare)
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All That Glitters Is Not Gold
- 2023
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Ingår i: European Journal of Vascular and Endovascular Surgery. - : Elsevier. - 1078-5884 .- 1532-2165. ; 66:2, s. 194-194
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)
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| 20. |
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| 21. |
- Wanhainen, Anders, et al.
(författare)
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Screening for abdominal aortic aneurysm
- 2019
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Ingår i: The Lancet. - : ELSEVIER SCIENCE INC. - 0140-6736 .- 1474-547X. ; 393:10166, s. 27-28
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Tidskriftsartikel (refereegranskat)
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| 22. |
- Wanhainen, Anders
(författare)
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Stor enighet om att screening för bukaortaaneurysm räddar liv : [Misleading study in The Lancet on the outcome of the Swedish AAA screening program]
- 2018
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Ingår i: Läkartidningen. - : Läkartidningen Förlag. - 0023-7205 .- 1652-7518. ; 115
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)abstract
- In a recent publication in The Lancet Johansson and colleagues claim no effect on aneurysm mortality among men participating in the Swedish AAA screening program, and question its justification. The study is, however, limited by a corrupt study design and incorrect data, making the publication misleading. On the contrary, several RCTs and contemporary nationwide data with sufficient follow-up clearly show that AAA screening saves lives and is highly cost-effective. The program has so far identified about 6000 men with an AAA, of whom 1500 have been operated on to prevent rupture. Thus, more than 750 men have experienced a longer life (by a mean of 8 years) as a result of the program. Continuous evaluation of the program is important but requires a scientifically sound methodology.
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| 23. |
- Wanhainen, Anders, et al.
(författare)
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The effect of ticagrelor on growth of small abdominal aortic aneurysms-a randomized controlled trial
- 2020
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Ingår i: Cardiovascular Research. - : Oxford University Press (OUP). - 0008-6363 .- 1755-3245. ; 116:2, s. 450-456
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Tidskriftsartikel (refereegranskat)abstract
- Aims: To evaluate if ticagrelor, an effective platelet inhibitor without known non-responders, could inhibit growth of small abdominal aortic aneurysms (AAAs). Methods and results: In this multi-centre randomized controlled trial, double-blinded for ticagrelor and placebo, acetylic salicylic acid naive patients with AAA and with a maximum aortic diameter 35-49mm were included. The primary outcome was mean reduction in log-transformed AAA volume growth rate (%) measured with magnetic resonance imaging (MRI) at 12months compared with baseline. Secondary outcomes include AAA-diameter growth rate and intraluminal thrombus (ILT) volume enlargement rate. A total of 144 patients from eight Swedish centres were randomized (72 in each group). MRI AAA volume increase was 9.1% for the ticagrelor group and 7.5% for the placebo group (P=0.205) based on intention-to-treat analysis, and 8.5% vs. 7.4% in a per-protocol analysis (P=0.372). MRI diameter change was 2.5mm vs. 1.8mm (P=0.113), US diameter change 2.3mm vs. 2.2mm (P=0.778), and ILT volume change 12.9% vs. 10.4% (P=0.590). Conclusion: In this RCT, platelet inhibition with ticagrelor did not reduce growth of small AAAs. Whether the ILT has an important pathophysiological role for AAA growth cannot be determined based on this study due to the observed lack of thrombus modulating effect of ticagrelor.
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