| 11. |
- Engström, Gunnar, et al.
(författare)
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Risk of treatment of peripheral arterial disease is related to inflammation-sensitive plasma proteins : a prospective cohort study
- 2004
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Ingår i: Journal of Vascular Surgery. - : Elsevier BV. - 1097-6809 .- 0741-5214. ; 40:6, s. 1101-1105
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Studies in patients with peripheral arterial disease (PAD) have reported an association between inflammatory markers and severity of disease or worsening of symptoms. However, few have studied the prognostic significance of inflammatory markers in asymptomatic subjects, measured many years before the onset of symptomatic PAD requiring treatment (trPAD).MATERIAL AND METHODS: Five inflammation-sensitive plasma proteins (ISPs), including fibrinogen, alpha 1-antitrypsin, haptoglobin, ceruloplasmin, and orosomucoid, were determined in 5619 healthy men (mean age, 46.8 +/- 3.7 years) without walking-induced calf pain. Data for men who subsequently underwent a revascularization procedure because of trPAD (intermittent claudication or critical ischemia) were retrieved from hospital-based registers. Future trPAD was studied in relation to the number of ISPs in the top quartile at the baseline examination.RESULTS: Seventy men (1.2%) underwent revascularization because of trPAD at a mean of 16.5 years after the baseline examination. The proportion with future trPAD was 0.4%, 1.0%, 1.5%, and 3.2%, respectively, for men with 0, 1, 2, and 3 or more ISPs in the top quartile (trend, P < .0001). After adjustment for age, screening year, systolic blood pressure, blood pressure medication, cholesterol concentration, diabetes, smoking, and tobacco consumption the corresponding odds ratios (95% confidence interval [CI]) were 1.00 (reference), 1.5 (CI, 0.7-3.6), 1.9 (CI, 0.8-4.6), and 2.9 (CI, 1.3-6.4), respectively, in these groups (trend, P = .003).CONCLUSION: Elevated ISPs, measured 16 years earlier in apparently healthy men without walking-induced calf pain, were associated with increased risk for development of PAD requiring revascularization.
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| 12. |
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| 13. |
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| 14. |
- Klefsgård, Rosemarie, et al.
(författare)
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A 1-year follow-up quality of life study after hemodynamically successful or unsuccessful surgical revascularization of lower limb ischemia
- 2001
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Ingår i: Journal of Vascular Surgery. - : Elsevier BV. - 1097-6809 .- 0741-5214. ; 33:1, s. 114-122
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Tidskriftsartikel (refereegranskat)abstract
- PURPOSE: The impact of hemodynamically successful or unsuccessful bypass grafting or angioplasty on patients' quality of life was assessed throughout the first year postsurgery. METHODS: A total of 146 patients, 97 patients who underwent successful revascularization and 49 patients who underwent unsuccessful revascularization, were assessed for quality of life with the Nottingham Health Profile. RESULTS: Hemodynamically successful revascularization resulted in an immediate and lasting impact on the patients' quality of life. Despite hemodynamic failure, patients had improvements in pain, emotional reactions, sleep, and family relationships at the 1-year follow-up assessment. A successful revascularization in patients with claudication demonstrated the most marked quality of life benefits, including all health dimensions that were not normal at baseline. Patients with critical ischemia had improved quality of life for pain, sleep, and physical mobility. High ankle pressure, in the claudicant group, and a high sense of coherence were significantly associated with high quality of life. CONCLUSION: The treatment of lower limb ischemia resulted in an immediate and relatively lasting improvement in patients' quality of life. Patients who underwent hemodynamically successful bypass grafting procedures or angioplasty demonstrated higher quality of life benefits than patients who underwent a failed bypass grafting procedure. Quality of life was further determined by means of the patients' sense of coherence.
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| 15. |
- Klefsgård, Rosemarie, et al.
(författare)
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Nottingham Health Profile and Short-Form 36 Health Survey questionnaires in patients with chronic lower limb ischemia: Before and after revascularization.
- 2002
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Ingår i: Journal of Vascular Surgery. - : Elsevier BV. - 1097-6809 .- 0741-5214. ; 36:2, s. 310-317
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: The purpose of this study was to compare the usefulness of the Nottingham Health Profile (NHP) and the Short-Form 36 Health Survey (SF-36) as general outcome measures after vascular intervention for lower limb ischemia with respect to patients' quality of life, on the basis of validity, reliability, and responsiveness analyses. Patients and Methods: Eighty patients, 40 with claudication and 40 with critical ischemia, were assessed before and one month after revascularization by using comparable domains of the NHP and the SF-36 questionnaires. RESULTS: The SF-36 scores were less skewed and were distributed more homogeneously than the NHP scores. Discriminate validity results showed that NHP was better than SF-36 in discriminating among levels of ischemia with respect to pain and physical mobility. For both questionnaires, the reliability standards were satisfactory in most respects. The NHP was more responsive than the SF-36 in detecting within-patient changes. All of the NHP domains not zero at baseline were improved significantly one month after hemodynamically successful revascularization for patients with claudication, whereas patients with critical ischemia showed significant abatement of pain and improvements in physical mobility and social isolation. The SF-36 scores indicated a significant decrease in bodily pain and improvements in physical functioning and vitality for patients with claudication, and decrease in bodily pain and improvement in physical functioning for patients with critical ischemia. CONCLUSIONS: The findings indicated that both NHP and SF-36 were reliable. The SF-36 scores were less skewed than the NHP scores, whereas NHP discriminated better among levels of ischemia and was more responsive in detecting quality-of-life changes over time than SF-36 in these particular patients.
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| 16. |
- Löfberg, Anne-Marie, et al.
(författare)
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Percutaneous transluminal angioplasty of the femoropopliteal arteries in limbs with chronic critical lower limb ischemia
- 2001
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Ingår i: Journal of vascular surgery. - : Elsevier BV. - 0741-5214. ; 34:1, s. 114-121
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Tidskriftsartikel (refereegranskat)abstract
- PURPOSE: The aim of the study was to evaluate the results of percutaneous transluminal angioplasty (PTA) of femoropopliteal arteries in patients with subcritical or critical lower limb ischemia. Materials and Methods: Ninety-two patients underwent 121 PTA procedures, 68 were of the superficial femoral artery (SFA), 13 of the popliteal and 40 of both arteries. Fifty-seven procedures were performed for treatment of occlusions. Eighty-four patients (94 procedures) were monitored with duplex scanning. RESULTS: Technical success rate was 88%. Primary success rates at 12 and 60 months in the whole series were 40% and 27%, respectively. The primary success rate in limbs with SFA occlusion of longer than 5 cm was only 12% after 5 years compared with 32% if the occlusion was CONCLUSION: The results of femoropopliteal PTA performed for treatment of subcritical or critical lower limb ischemia seemed to be inferior to the results of infrainguinal bypass grafting reported in literature. However, because the PTA procedure does not preclude the performance of bypass grafting, it might be an alternative to surgical intervention in limbs with stenotic femoropopliteal lesions. PTA might also be considered in patients with high surgical risk and limited life expectancy, having short occlusive lesions (< 5 cm).
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| 17. |
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| 18. |
- Sandgren, T., et al.
(författare)
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Arterial dimensions in the lower extremities of patients with abdominal aortic aneurysms - No indications of a generalized dilating diathesis
- 2001
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Ingår i: Journal of Vascular Surgery. - : Elsevier BV. - 0741-5214 .- 1097-6809. ; 34:6, s. 1079-1084
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Tidskriftsartikel (refereegranskat)abstract
- Purpose: This study assessed whether there is a dilating diathesis in peripheral arteries of patients with abdominal aortic aneurysms (AAAs). Methods: The anteroposterior diameters of the common femoral artery (CFA) and popliteal artery (PA) were measured in 183 consecutive patients with an AAA (158 men, 25 women, age range, 57-78 years) before elective surgery on the AAA and compared with that of healthy age-matched control subjects. The diameter registrations were performed on the right leg by using a noninvasive echo-tracking ultrasound scanning technique. Results: Eight CFA aneurysms and four PA aneurysms were found in the male patients with AAAs. Of the patients with AAAs in the CFA and in the PA who were investigated, 46% and 49%, respectively, were affected by peripheral vascular occlusive disease (PVOD). The CFA diameters in the patients with AAAs were 97.8% of those in healthy control subjects (P = not significant [NS]). After exclusion of the CFA aneurysms, the diameters were 92.7% of those in healthy control subjects (P = .0003). If patients with PVOD were also excluded, the CFA diameters were 95.2% of those in healthy control subjects (P = .022). The PA diameters in the patients with AAAs were 97.8% of those in healthy control subjects (P = NS). If PA aneurysms were excluded, the diameters were 94.4% of those in healthy control subjects (P = .0003). If patients with PVOD were also excluded, the PA diameters were 96.1% of those in healthy control subjects (P = NS). Conclusion: After excluding the few patients with AAAs who had peripheral aneurysmal disease and the patients with PVOD, no dilating diathesis in CFAs and PAs was found. This supports the hypothesis that specific genetic, or other factors, not present in most AAAs are responsible for the occurrence of concomitant peripheral aneurysms. Furthermore, the generalized vascular dilating diathesis seen in some patients seems to be a specific entity that was not necessarily affiliated with AAA disease.
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| 19. |
- Schurink, G W, et al.
(författare)
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Pulsatile wall motion and blood pressure in aneurysms with open and thrombosed endoleaks--comparison of a wall track system and M-mode ultrasound scanning: an in vitro and animal study
- 2000
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Ingår i: Journal of Vascular Surgery. - : Elsevier BV. - 1097-6809 .- 0741-5214. ; 32:4, s. 795-803
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: Pulsatile wall motion has been suggested as a means by which to evaluate abdominal aortic aneurysms after exclusion from the circulation to determine whether the treatment has been effective. The objective of this study was to investigate the relations between pulsatile wall motion and both the mean and pulse pressures within the aneurysmal sac for both patent and thrombosed endoleaks. Furthermore, we compared the measurements of pulsatile wall motion by means of M-mode ultrasound scanning and a wall track system to determine the most reliable technique. METHODS: First, interobserver and intraobserver variability of M-mode ultrasound scan measurements was determined at different pressure levels in a cow iliac artery placed in an in vitro circulation. M-mode ultrasound scanning and a wall track system were compared in the same model. Second, in an animal experiment, an aneurysm and endoleak model with both patent and thrombosed endoleaks was created. Systemic and aneurysmal mean and pulse pressures were recorded synchronically with pulsatile wall motion by means of M-mode ultrasound scanning and a wall track system. RESULTS: The intraobserver and interobserver variability values for M-mode ultrasound scan measurement in vitro were 0.11 mm (SD = 0.10 mm) and 0.15 mm (SD = 0.13 mm), respectively. In the animal study, a significant difference existed with respect to the level of pulse pressure within the aneurysmal sac between the group with pulsatile wall motion and the group without such motion (P <.0001). The presence of pulsatile wall motion was not correlated with the level of aneurysmal mean pressure. The level of pulsatile wall motion determined by means of M-mode ultrasound scanning correlated well with the level determined by means of the wall track system (r = 0. 74; P =.01). For the level of pulsatile wall motion determined by means of M-mode ultrasound scanning, a significant difference between patent and thrombosed endoleaks existed (P =.04). For detecting endoleaks, the sensitivity and specificity of pulsatile wall motion as determined by means of the wall track system were 52% and 100%, respectively, and the sensitivity and specificity of pulsatile wall motion as determined by means of M-mode ultrasound scanning were 64% and 67%, respectively. For the detection of pulse pressure in the aneurysmal sac, the sensitivity and specificity of pulsatile wall motion as determined by means of the wall track system were 76% and 100%, respectively, and the sensitivity and specificity of pulsatile wall motion as determined by means of M-mode ultrasound scanning were 90% and 71%, respectively. CONCLUSIONS: We found that pulsatile wall motion is correlated with aneurysmal pulse pressure but not with the mean level of pressure inside the aneurysm. Although measurements of pulsatile wall motion are of great theoretic value when groups of patients who have undergone endovascular aneurysm repair are being compared, this method appears to be unreliable in a clinical setting with respect to determining whether the aneurysmal sac is still pressurized in individual patients.
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| 20. |
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