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| 2. |
- Acosta, Stefan, et al.
(author)
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Predictors for Outcome After Open and Endovascular Repair of Ruptured Abdominal Aortic Aneurysms.
- 2007
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In: European Journal of Vascular and Endovascular Surgery. - : Elsevier BV. - 1532-2165 .- 1078-5884. ; 33:Nov 8, s. 277-284
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Journal article (peer-reviewed)abstract
- Objectives. The aims of the present study were to analyze patient- and management-related predictors for outcome after open (OR) and endovascular repair (EVAR) of ruptured abdominal aortic aneurysm (rAAA). Design. Retrospective study. Materials. The in-hospital registry of Malmo University Hospital identified 162 patients operated on due to rAAA between 2000 and 2004. Methods. Patient- and management-related predictors for outcome were analysed. Results. Preoperative CT in 39 out of 62 circulatory unstable patients was not associated with increased mortality (P = 0.60). There was a significant increase in repairs performed by EVAR during the study period (p < 0.001), and in 2004 EVAR exceeded the annual rate of OR. Patients in the EVAR group were older (p = 0.025), whereas patients in the OR group more often suffered from unconsciousness after presentation (p = 0.004). Age, unconsciousness after presentation and haemoglobin were significantly associated with in-hospital mortality when tested in a multivariate logistic regression model (p = 0.002, p = 0.003 and p < 0.001, respectively). The in-hospital mortality for patients undergoing OR and EVAR was 45% (48/106) and 34% (19/56), respectively (p = 0.16). Diagnosis of abdominal compartment syndrome (p = 0.005) and intestinal infarction (p = 0.002) was associated with poor survival. Conclusions. Patient-related factors such as age, loss of consciousness and haemoglobin predicts outcome in a population where both emergency OR and EVAR for the treatment of rAAA is feasible.
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- Danielsson, Gudmundur, et al.
(author)
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Percutaneous transluminal angioplasty of crural arteries: diabetes and other factors influencing outcome
- 2001
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In: European Journal of Vascular and Endovascular Surgery. - : Elsevier BV. - 1532-2165 .- 1078-5884. ; 21:5, s. 432-436
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Journal article (peer-reviewed)abstract
- OBJECTIVE: to evaluate the efficacy of percutaneous transluminal angioplasty (PTA) of the crural arteries. PATIENTS AND METHODS: a retrospective review of patients treated with PTA of at least one crural artery during an 8-year period (1990--1997). RESULTS: one hundred and fifty-five legs in 140 consecutive patients (mean age 74 years, range 38--91 years) were treated. In 76% a more proximal lesion was also treated. After 1 year, results were significantly better in non-diabetics (improvement rate of 66% vs 32%p <0.05). The outcome for patients with a combination of diabetes, heart disease and renal disease was significantly worse compared to all other patients with an improvement rate of only 9% after 1 year. Patients alive and not amputated at 1 year were significantly more common (p <0.05) among non-diabetics (90%), compared to diabetics (66%). The 1-year mortality for the whole group was 15%, significantly higher for diabetic patients (p =0.04). CONCLUSION: PTA of crural arteries produces reasonably good results in non-diabetic patients. Diabetic patients were doing worse than non-diabetics after a year, though 1-month results were not significantly different. Patients with diabetes, heart disease and renal disease make a high-risk group that has a significantly worse outcome.
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- Engellau, Lena, et al.
(author)
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Magnetic resonance imaging and MR angiography of endoluminally treated abdominal aortic aneurysms
- 1998
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In: European Journal of Vascular and Endovascular Surgery. - 1532-2165. ; 15:3, s. 212-219
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Journal article (peer-reviewed)abstract
- OBJECTIVES: To evaluate magnetic resonance imaging (MRI) with gadolinium-based contrast medium-enhanced MR angiography (MRA) for the follow-up of endoluminally treated abdominal aortic aneurysms. DESIGN: MRI/MRA, angiography and computed tomography (CT) were performed 1 month after endoluminal stent-graft placement. MRI/MRA was repeated at 6 and 12 months and angiography and CT were added to confirm unexpected findings. MATERIALS: Fifteen male patients with endoluminally treated abdominal aortic aneurysms. METHODS: MRI with MRA, spiral CT with transverse images and angiography were performed. RESULTS: MRI/MRA demonstrated changes of stent-graft morphology, aortic neck- and aneurysmal diameter, stent-graft blood flow, stent-graft leakage, blood flow in lumbar arteries, intra-aneurysmal thrombus, periaortic inflammation and vertebral body infarction. For most of these features MRI/MRA provided more information than angiography and/or CT. MRI was the only method demonstrating thrombus reorganisation and vertebral body infarction. CONCLUSIONS: MRI with MRA provides the relevant information needed for follow-up of endoluminally treated abdominal aortic aneurysms (AAA). This may be the method of choice because of its use of contrast media with very low nephrotoxicity, lack of ionising radiation and non-invasiveness.
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- Norgren, L, et al.
(author)
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Endovaskulär teknik vid aortaaneurysm. Lovande alternativ till öppen kirurgi
- 1998
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In: Läkartidningen. - 0023-7205. ; 95:6, s. 508-512
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Journal article (peer-reviewed)abstract
- The article consists in a presentation of endovascular surgery for abdominal aortic aneurysm repair in 23 cases. Two cases required conversion to open surgery, but the procedure could be completed in the remaining 21 cases, with a current duration of follow-up of up to 30 months. There was early leakage in one case, and late leakage in five cases. Late conversion has been necessary in three instances, and supplementary endovascular measures have been required in a further two instances. All complications have occurred in those cases operated during the first half of the study period. Modification of the endoprosthesis used and increasing skill have reduced both operation time and the complication rate. Intensive care is no longer required, and the median duration of hospitalisation is three days. Follow-up with magnetic resonance imaging has yielded new and important information.
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| 6. |
- Zdanowski, Z, et al.
(author)
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Outcome of treatment of ruptured abdominal aortic aneurysms depending on the type of hospital.
- 2002
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In: European Journal of Surgery. - : Oxford University Press (OUP). - 1102-4151. ; 168:2, s. 96-100
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Journal article (peer-reviewed)abstract
- OBJECTIVE: To compare the outcome of patients operated on acutely for ruptured abdominal aortic aneurysms (AAA) or otherwise symptomatic aortic aneurysms in a university hospital and in two county hospitals by the same group of vascular surgeons. DESIGN: Retrospective study. SETTING: 1 university and 2 county hospitals, Sweden. SUBJECTS: 108 patients operated on urgently for AAA, 81 at the university hospital, and 27 at the county hospitals between January 1992 and December 1998. INTERVENTION: Repair of the AAA. MAIN OUTCOME MEASURES: Morbidity and mortality. RESULTS: 21 of the 81 patients having urgent repair of an AAA at the university hospital (26%) had been transferred from the county hospitals. Thirteen patients were not operated on, 7 because of their poor general condition and great age (median 84 years), 3 who refused operation, and 3 in whom the diagnosis was incorrect. During the same time period a further 27 haemodynamically unstable patients were operated on by the same vascular surgeons at the county hospitals. The on-table mortality for patients with ruptured AAA and shock was 5/43 (12%) at the university hospital and 4/27 (15%) at the county hospitals. The corresponding in-hospital rates were 11/43 (26%) and 11/27 (41%). Mortality was significantly higher if the operation was delayed by more than 45 minutes. The incidence of postoperative complications was the same in both hospitals. CONCLUSION: If a patient with a ruptured AAA and shock is admitted to the county hospital and operated on by a specialist vascular surgeon the outcome is fully acceptable. The difference seems to be related to the postoperative period. To what extent the delay caused by the surgeon's journey to the county hospital has any influence on the outcome is not possible to evaluate.
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