| 1. |
- Boström, Annika, et al.
(författare)
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Duplex scanning as the sole preoperative imaging method for infrainguinal arterial surgery
- 2002
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Ingår i: European Journal of Vascular and Endovascular Surgery. - : Elsevier BV. - 1078-5884 .- 1532-2165. ; 23:2, s. 140-145
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: to evaluate preoperative duplex as the sole investigation prior to lower limb reconstruction. Design retrospective analysis. MATERIALS AND METHODS: between January 1995 and December 1999, 157 of 329 surgical interventions for chronic infrainguinal arterial or aneurysmal disease were performed without preoperative angiography. RESULTS: in patients undergoing femoral artery endarterectomy, the extent of the stenosis and the status of the distal deep femoral artery were correctly diagnosed with duplex scanning in all but one patient. Duplex scan findings in patients undergoing infrainguinal bypass procedures were in agreement with the findings obtained from on-table angiography in regard to the selection of optimal outflow anastomotic sites in 123 (98%). Duplex scanning correctly evaluated the status of runoff in 113 (90%). There were no significant differences in 30-day occlusion rate and patency at 12 months between reconstructions performed with and without preoperative angiography. CONCLUSION: in patients with conclusive duplex scan findings there is no need to perform angiography prior to lower limb reconstruction.
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| 2. |
- Boström Ardin, Annika, et al.
(författare)
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Surgical reconstruction without preoperative angiography in patients with aortoiliac occlusive disease
- 2002
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Ingår i: Annals of Vascular Surgery. - : Elsevier BV. - 0890-5096 .- 1615-5947. ; 16:3, s. 273-278
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Tidskriftsartikel (refereegranskat)abstract
- The objective of this study was to evaluate the feasibility of performing surgical reconstructions in patients with aortoiliac occlusive disease with findings obtained solely from duplex scanning. Between January 1995 through December 1999, among 112 patients who underwent surgical intervention due to aortoiliac occlusive disease, 44 were operated on with findings obtained solely from preoperative duplex scanning. Deviations from preoperatively planned surgical interventions according to duplex scan findings and the outcome were analyzed. Our results showed that surgical reconstructions for treatment of aortoiliac occlusive disease can be safely performed by using duplex scanning as the sole preoperative diagnostic modality in patients with conclusive duplex scan findings.
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| 3. |
- Kragsterman, Björn, et al.
(författare)
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Risk factors for complications after carotid endarterectomy : a population-based study
- 2004
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Ingår i: European Journal of Vascular and Endovascular Surgery. - : Elsevier BV. - 1078-5884 .- 1532-2165. ; 28:1, s. 98-103
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES: The overall benefit of carotid endarterectomy (CEA) is dependent on the outcome from the procedure. However, many reports are from selected centres and not population-based. The aim of this study was to assess the 30-day complication rate for a whole country and also to determine independent risk factors for serious complications. MATERIALS AND METHODS: One thousand five hundred and eighteen CEA were retrospectively reviewed, covering principally all the CEAs in Sweden, during a three year period. Indications for surgery were; minor stroke 34%, TIA 34%, amaurosis fugax 18%, asymptomatic 11% and others 3%. Data were collected from the Swedish Vascular Registry (Swedvasc). Combined cohort and case-control methodology was used. RESULTS: Registered complications were; 43 permanent strokes, 32 transient strokes (<30 days), 18 TIA/amaurosis fugax and 22 deaths (seven fatal stokes). In the cohort study, the 30-day permanent stroke and death rate were 4.3% (65/1518). Significant risk factors in multivariate analyses were the indication for surgery (minor stroke vs. other indications) (p=0.02, RR=1.38), diabetes (p=0.02, RR=1.41), cardiac disease (p<0.01, RR 1.43) and operation at a university hospital (p=0.02, RR=1.39). In the case-control study comparing the 65 cases of permanent stroke and/or death with 130 matched controls the only significant risk factor was contralateral occlusion (p<0.01, OR=5.27). One patient (1/130) with a permanent stroke was wrongly reported as a local neurological complication (facial paresis). CONCLUSION: This national audit demonstrated population-based data on complication rates after CEA well comparable with previous randomised trials. The validity of the Swedvasc data was confirmed. Combined cohort and case-control methodology was useful in analysing risk factors for serious perioperative complications.
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| 4. |
- Logason, Karl, et al.
(författare)
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Carotid artery endarterectomy solely based on duplex scan findings
- 2002
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Ingår i: Vascular and endovascular surgery. - : SAGE Publications. - 1538-5744 .- 1938-9116. ; 36:1, s. 9-15
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Tidskriftsartikel (refereegranskat)abstract
- The purpose of this study was to review experience with carotid artery surgery based on findings obtained solely from duplex scanning with special regard to unexpected findings during surgery and the early outcome. From January 1993 through December 1999, 271 consecutive patients underwent 287 carotid endarterectomies (CEAs), 229 (80%) of which were performed solely based on duplex scan findings. During the study period 5,932 carotid artery duplex scans were performed in 4,466 patients. Of 589 patients with internal carotid artery (ICA) stenosis 70%, 246 underwent CEA compared to 25 of 156 with 50-69% ICA stenosis. The indications for CEA were transient ischemic attack (TIA) in 88 (30.7%), amaurosis fugax in 60 (20.9%), previous stroke in 91 (31.7%) and asymptomatic disease in 48 (16.7%) cases. There were no statistically significant differences between the groups operated on with and without preoperative angiography with respect to the indications for surgery, associated risk factors, or the degree of stenosis on the contralateral side. In patients undergoing surgery without angiography, there were no unexpected findings that influenced the performance of surgery, in all except 1. There were no significant differences in perioperative morbidity and mortality in patients undergoing surgery with and without conventional angiography. The combined mortality and major stroke rates were 3.4% and 2.2%, respectively. It is concluded that CEA can safely be performed without preoperative angiography in cases with conclusive duplex scan findings.
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| 5. |
- Logason, Karl, et al.
(författare)
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Duplex scan findings in patients with spontaneous cervical artery dissections
- 2002
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Ingår i: European Journal of Vascular and Endovascular Surgery. - : Elsevier BV. - 1078-5884 .- 1532-2165. ; 23:4, s. 295-298
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Tidskriftsartikel (refereegranskat)abstract
- AIM: to report duplex scan findings in patients with spontaneous internal carotid artery (ICA) or vertebral artery (VA) dissection. MATERIAL AND METHODS: the records of 24 patients (13 males and 11 females, median age 48 years [range 25-68 years]) with spontaneous extracranial ICA dissection (n=20) or VA dissection (n=4), identified between January 1995 and December 1999, were retrospectively analysed. RESULTS: four different abnormal flow patterns were observed in patients with ICA dissection: (a) absence of flow (15%), (b) staccato flow (50%), (c) reduced flow velocity (25%) and, (d) stenotic flow (10%). B-mode ultrasound showed a homogenous echolucent lesion in eight patients and a double lumen in two. Staccato flow along the entire ICA was observed in only four patients without verified dissection during the study period. In the four patients with VA dissection, duplex scanning demonstrated staccato flow in three and reversed low-amplitude pulsatile flow in one. CONCLUSION: duplex scanning is an important noninvasive diagnostic modality in patients with cervical artery dissection. Staccato flow along the extracranial ICA strongly indicates the presence of spontaneous ICA dissection.
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| 6. |
- Logason, Karl, et al.
(författare)
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Low molecular weight heparin (enoxaparin) versus dextran in the prevention of early occlusion following arterial bypass surgery distal to the groin
- 2001
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Ingår i: European Journal of Vascular and Endovascular Surgery. - : Elsevier BV. - 1078-5884 .- 1532-2165. ; 21:3, s. 261-265
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Tidskriftsartikel (refereegranskat)abstract
- AIM: to compare the effect of perioperative dextran and low molecular weight heparin on early graft patency after femorodistal bypass surgery. DESIGN: prospective randomised multicentre study. PATIENTS AND METHODS: three hundred and fourteen patients were randomised to dextran 70 or the low molecular weight heparin enoxaparin during and after femorodistal bypass surgery. Patency was evaluated at days 1, 5-7, 30 and 90. RESULTS: there was no difference in patency at any time point between the two regimens, the crude 90 days patency being 88 and 83%, respectively. There were significantly more patients with heart failure in the dextran group (12.8 vs 0.7%), with other side effects being evenly distributed. CONCLUSION: dextran 70 and the low molecular weight heparin enoxaparin have the same effect on 90 days femorodistal graft patency, but care must be taken using the dextran to patients with a potential heart insufficiency.
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| 7. |
- Logason, Karl, et al.
(författare)
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The impact of different spectral Doppler criteria on the proportion of high-grade internal carotid artery stenosis in patients undergoing duplex scanning
- 2002
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Ingår i: Angiology. - : SAGE Publications. - 0003-3197 .- 1940-1574. ; 53:3, s. 297-301
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Tidskriftsartikel (refereegranskat)abstract
- AIM: To investigate the impact of different spectral Doppler criteria on the proportion of high-grade ICA stenosis in patients undergoing carotid artery duplex scanning. MATERIAL AND METHODS: Duplex scans of 4,548 internal carotid arteries (ICA) in 2,349 patients were retrospectively analyzed. The following different criteria were applied for each scan for definition of ICA stenosis > or = 70%: Criteria I=ICA peak systolic velocity (PSV) > 130 cm/sec and ICA end-diastolic (EDV) > 100 cm/sec, Criteria II=PSV ICA/common carotid artery (CCA) ratio > 4, Criteria III=ICA PSV > or = 230 cm/sec, Criteria IV=ICA PSV > 230 cm/sec and/or ICA EDV > or = 100 cm/sec and/or PSV ICA/CCA ratio > or = 3.2. RESULTS: The frequency of detecting a > or = 70% ICA stenosis with criteria I, II, III, and IV were 5.5%, 6.8%, 8.4%, and 9.6%, respectively (p < 0.05). CONCLUSION: The use of various duplex criteria significantly affected the number of scans receiving a diagnosis of ICA stenosis of > or = 70%.
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| 8. |
- Logason, Karl, et al.
(författare)
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The importance of Doppler angle of insonation on differentiation between 50-69% and 70-99% carotid artery stenosis
- 2001
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Ingår i: European Journal of Vascular and Endovascular Surgery. - : Elsevier BV. - 1078-5884 .- 1532-2165. ; 21:4, s. 311-313
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Tidskriftsartikel (refereegranskat)abstract
- AIM: to investigate the importance of Doppler angle differentiating between 50-69% and >/=70% internal carotid artery (ICA) stenosis. MATERIAL AND METHODS: fifty-one patients with a previous diagnosis of 50-69% ICA stenosis (n =53) were re-evaluated by duplex scanning. Spectral Doppler velocity waveforms were obtained from common carotid (CCA), ICA and external (ECA) carotid arteries with the same Doppler angle of insonation as used at the initial duplex scanning, followed by repeated measurements with a fixed 60 degrees angle of insonation. RESULTS: the peak systolic velocity (PSV) in the ICA was 181+/-55 cm/s (mean+/-SD) at the second duplex scanning when the same angle of insonation (mean 46 degrees +/-9) was used as during the initial investigation. When the examination was done with a 60 degrees angle of insonation, PSV ICA was 261+/-96 cm/s (mean+/-SD). In fifteen arteries the estimated degree of ICA stenosis changed from 50-69% to 70-99% due to the application of a fixed Doppler angle of insonation at 60 degrees. CONCLUSION: the Doppler angle of insonation has a significant effect on spectral Doppler velocity measurements. It is crucial that duplex criteria are standardised with a fixed angle of insonation and that this angle is consistently used during velocity estimations.
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| 9. |
- Logason, Karl
(författare)
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The role of duplex scanning in the management of carotid artery disease
- 2001
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Extracranial carotid artery disease, mainly due to atherosclerosis, is a common cause of stroke. The risk for future stroke can be reduced in selected patients by carotid endarterectomy (CEA). Duplex scanning has been increasingly used for diagnosis of carotid artery disease. The aim of this thesis was to assess the role of duplex scanning in the management of carotid artery disease by evaluating various methodological and clinical aspects of its use. Retrospective analysis of 4,548 carotid artery duplex scans demonstrated that different validated spectral Doppler criteria had a significant effect on the proportion of patients receiving a diagnosis of ≥70% internal carotid artery (ICA) stenosis. The Doppler angle of insonation significantly affects velocity measurements and is important in differentiating 50-69% and ≥70% ICA stenosis. Two hundred eighty seven consecutive carotid endarterectomies were analysed retrospectively. The perioperative major stroke/mortality rate was 2.2% in 229 operations with duplex scanning as the sole preoperative imaging modality. Early postoperative duplex scanning was technically feasible and a high ICA flow velocity after CEA was often transient. In 24 patients with spontaneous cervical artery dissections, four pathological flow patterns were identified: absence of flow, reduced flow, staccato flow and stenotic flow. Duplex scanning has important implications in the management of patients with extracranial carotid artery disease. However, duplex performance depends on correct application of the method and selection of appropriate criteria for the definition of disease. Duplex scanning can be reliably used to select patients for CEA. Moreover it is a useful diagnostic modality in the immediate postoperative period. Finally, it can be reliably used for diagnosis of spontaneous cervical artery dissections.
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