| 1. |
- Lyttkens, Linda
(author)
-
Health Related Quality of Life in patients with screening detected Sub-Aneurysmal aorta and Abdominal Aortic Aneurysm
- 2023
-
Licentiate thesis (other academic/artistic)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.
|
|
| 2. |
- Thorbjørnsen, Knut
(author)
-
Aspects of subaneurysmal aortas in a screening setting
- 2023
-
Doctoral thesis (other academic/artistic)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.
|
|
| 3. |
- Thorbjørnsen, Knut, et al.
(author)
-
Morphological factors associated with progression of subaneurysmal aortas
- 2023
-
In: British Journal of Surgery. - : Oxford University Press. - 0007-1323 .- 1365-2168. ; 110:4, s. 489-497
-
Journal article (peer-reviewed)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.
|
|
| 4. |
- Wanhainen, Anders, et al.
(author)
-
All That Glitters Is Not Gold
- 2023
-
In: European Journal of Vascular and Endovascular Surgery. - : Elsevier. - 1078-5884 .- 1532-2165. ; 66:2, s. 194-194
-
Journal article (other academic/artistic)
|
|
