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Editor's choice: five-year outcomes in men screened for abdominal aortic aneurysm at 65 years of age: a population-based cohort study.

https://arctichealth.org/en/permalink/ahliterature106028
Source
Eur J Vasc Endovasc Surg. 2014 Jan;47(1):37-44
Publication Type
Article
Date
Jan-2014
Author
S. Svensjö
M. Björck
A. Wanhainen
Author Affiliation
Department of Surgical Sciences, Section of Vascular Surgery, Uppsala University, Uppsala, Sweden; Department of Surgery, Falun County Hospital, Falun, Sweden. Electronic address: sverker.svensjo@ltdalarna.se.
Source
Eur J Vasc Endovasc Surg. 2014 Jan;47(1):37-44
Date
Jan-2014
Language
English
Publication Type
Article
Keywords
Age Factors
Aged
Aorta, Abdominal - surgery - ultrasonography
Aortic Aneurysm, Abdominal - epidemiology - surgery - ultrasonography
Chi-Square Distribution
Humans
Longitudinal Studies
Male
Mass Screening - methods
Predictive value of tests
Prevalence
Prognosis
Proportional Hazards Models
Risk factors
Sex Factors
Sweden - epidemiology
Time Factors
Abstract
Acquiring contemporary data on prevalence and natural history of abdominal aortic aneurysms (AAA) is essential in the effort to optimise modern screening programmes. The primary aim of this study was to determine the fate of a 65-year-old male population 5 years following an invitation to an aortic ultrasound (US) examination.
In this population-based cohort-study, men were invited to US examination at age 65, and were re-invited at age 70. Mortality, AAA repair, and risk factors were recorded. An AAA was defined as a diameter =30 mm, and a sub-aneurysmal aorta as 25-29 mm.
In 2006-2007, 3,268 65-year-old men were invited, and 2,736 (83.7%) were examined. After 5 years, 24 had completed AAA repair (6 died within 0-4 years), an additional 239 had died, and 194 had moved. Thus, 2,811 70-year-old men were re-invited, and 2,247 (79.9%) were examined. The AAA prevalence increased from 1.5% at 65 to 2.4% (95% CI: 1.8 to 3.0) at 70, and of sub-aneurysmal aortas from 1.7% at 65 to 2.6% (2.0 to 3.3), at 70. Of 2,041 with
PubMed ID
24262320 View in PubMed
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The value of a nationwide vascular registry in understanding contemporary time trends of abdominal aortic aneurysm repair.

https://arctichealth.org/en/permalink/ahliterature156517
Source
Scand J Surg. 2008;97(2):142-5
Publication Type
Article
Date
2008
Author
A. Wanhainen
K. Mani
M. Björck
Author Affiliation
Department of Surgical Sciences, Section of Vascular Surgery, Uppsala University Hospital, Uppsala, Sweden. andwan@algonet.se
Source
Scand J Surg. 2008;97(2):142-5
Date
2008
Language
English
Publication Type
Article
Keywords
Aortic Aneurysm, Abdominal - surgery
Humans
Registries
Sweden
Abstract
Nationwide vascular registries offer rapid feed-back in an environment of fast new technical development, as is the case with the treatment of abdominal aortic aneurysm (AAA). Furthermore, they offer an opportunity to study non-selected, population-based data. The aim of this review was to analyze time-trends in published papers from nationwide registries on AAA-repair. In contrast to several US reports, an increased rate of intact AAA repair, associated with the introduction of endovascular repair, was reported in a recent publication based on the Swedish Vascular Registry (Swedvasc). The rate of ruptured abdominal aortic aneurysm (rAAA) repair is stable in most reports, while some report a decreasing incidence. Most nationwide studies report a reducing mortality over time after intact AAA repair, while time trends on the mortality after ruptured AAA repair are more heterogenic.
PubMed ID
18575033 View in PubMed
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Changes in the management of infrarenal abdominal aortic aneurysm disease in Sweden.

https://arctichealth.org/en/permalink/ahliterature117098
Source
Br J Surg. 2013 Apr;100(5):638-44
Publication Type
Article
Date
Apr-2013
Author
K. Mani
M. Björck
A. Wanhainen
Author Affiliation
Department of Surgical Sciences, Section of Vascular Surgery, Uppsala University, 75185 Uppsala, Sweden. kevin.mani@surgsci.uu.se
Source
Br J Surg. 2013 Apr;100(5):638-44
Date
Apr-2013
Language
English
Publication Type
Article
Keywords
Age Distribution
Aged
Aged, 80 and over
Analysis of Variance
Aortic Aneurysm, Abdominal - mortality - surgery
Aortic Rupture - mortality - surgery
Endovascular Procedures - mortality - trends
Humans
Middle Aged
Perioperative Care - mortality
Postoperative Complications - mortality
Prospective Studies
Sweden - epidemiology
Abstract
Treatment of abdominal aortic aneurysm (AAA) has changed over time, with endovascular repair (EVAR) being the main technical revolution. This study assessed the effect of this change on outcome on a national basis over a 17-year interval.
Primary infrarenal AAA repairs in Swedish residents aged 50 years and older, in the Swedish Vascular Registry (Swedvasc) 1994-2010, were analysed. The rate per 100,000 population, patient characteristics, operative technique and outcome were assessed for the intervals 1994-1999, 2000-2005 and 2006-2010.
Some 11,336 intact aneurysm repairs were performed. The overall rate per 100,000 increased (18.4 in 1994-1999, 19.4 in 2000-2005 and 24.0 in 2006-2010; P
PubMed ID
23334950 View in PubMed
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Current prevalence of abdominal aortic aneurysm in 70-year-old women.

https://arctichealth.org/en/permalink/ahliterature118567
Source
Br J Surg. 2013 Feb;100(3):367-72
Publication Type
Article
Date
Feb-2013
Author
S. Svensjö
M. Björck
A. Wanhainen
Author Affiliation
Department of Surgical Sciences, Section of Vascular Surgery, Uppsala University, Uppsala, Sweden. sverker.svensjo@ltdalarna.se
Source
Br J Surg. 2013 Feb;100(3):367-72
Date
Feb-2013
Language
English
Publication Type
Article
Keywords
Aged
Aortic Aneurysm, Abdominal - epidemiology - etiology - ultrasonography
Female
Humans
Mass Screening
Medical Futility
Prevalence
Registries
Risk factors
Smoking - epidemiology
Sweden - epidemiology
Abstract
Screening elderly men for abdominal aortic aneurysm (AAA) to reduce mortality from rupture is evidence-based. For women epidemiological data on AAA are scarce, and the evidence for screening is insufficient. The aim of this population-based study was to determine the current prevalence of AAA and risk factors among 70-year-old women.
All 70-year-old women identified through the National Population Registry in the two neighbouring counties of Uppsala and Dalarna were invited to a free ultrasound examination of the abdominal aorta. An AAA was defined as a maximum infrarenal aortic diameter of at least 30 mm.
Of 6925 women invited, 5140 (74·2 per cent) accepted the invitation to be screened. Among these, 19 AAAs were detected (0·4 (95 per cent confidence interval (c.i.) 0·2 to 0·5) per cent). In the invited cohort 12 women (0·2 (0·1 to 0·3) per cent) had undergone previous AAA repair (11) or had a known AAA under surveillance (1). Thus, the total prevalence was estimated at 0·5 (0·4 to 0·7) per cent. Smoking was strongly associated with AAA; 18 (95 per cent) of 19 women with a screen-detected AAA had a history of smoking compared with 44·2 per cent of those with a normal aorta (odds ratio 20·29, 95 per cent c.i. 2·70 to 152·65). The prevalence of AAA was 0·03 (0 to 0·1) per cent among never smokers, 0·4 (0·2 to 0·8) per cent among former smokers and 2·1 (1·0 to 3·7) per cent among current smokers.
Screening 70-year-old women who do not smoke is likely to be futile, thus ruling out population screening of women for AAA.
PubMed ID
23192439 View in PubMed
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Change in smoking habits after having been screened for abdominal aortic aneurysm.

https://arctichealth.org/en/permalink/ahliterature103005
Source
Eur J Vasc Endovasc Surg. 2014 Aug;48(2):138-43
Publication Type
Article
Date
Aug-2014
Author
S. Bohlin
C. Fröjd
A. Wanhainen
M. Björck
Author Affiliation
Department of Surgical Sciences, Vascular Surgery, Uppsala University, Uppsala, Sweden.
Source
Eur J Vasc Endovasc Surg. 2014 Aug;48(2):138-43
Date
Aug-2014
Language
English
Publication Type
Article
Keywords
Aged
Aortic Aneurysm, Abdominal - diagnosis - epidemiology
Case-Control Studies
Counseling
Health Behavior
Health Knowledge, Attitudes, Practice
Humans
Hypertension - epidemiology
Male
Mass Screening
Predictive value of tests
Risk factors
Risk Reduction Behavior
Smoking - adverse effects - epidemiology - prevention & control
Smoking Cessation
Sweden - epidemiology
Abstract
To study smoking habits among men with abdominal aortic aneurysm at screening at 65 years of age, and during follow-up, as a base-line study to evaluate future interventions.
Nested case-control study.
Between 2006 and 2011, 8150 65-year-old men (compliance 85%) were screened for AAA in Uppsala County, Sweden. Among 292 men with an aortic diameter of at least 25 mm, 77 were active smokers at the time of screening. At follow-up of smoking habits in 2012, 53 men (69%) participated in this study, 28 had an AAA of at least 30 mm and 25 a sub-aneurysmal aorta (SAA) 25-29 mm at baseline. For each case, one control was randomly selected, all active smokers with aortic diameter less than 25 mm at baseline, matched for age and year of screening. Telephone interviews were performed at a median 34 months (range: 4-67) after screening.
Men with AAA had hypertension more often than controls (68% vs. 23%, p
PubMed ID
24878236 View in PubMed
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Carotid artery atherosclerosis among 65-year-old Swedish men - a population-based screening study.

https://arctichealth.org/en/permalink/ahliterature103069
Source
Eur J Vasc Endovasc Surg. 2014 Jul;48(1):5-10
Publication Type
Article
Date
Jul-2014
Author
D. Högberg
B. Kragsterman
M. Björck
J. Tjärnström
A. Wanhainen
Author Affiliation
Department of Surgical Sciences, Section of Vascular Surgery, Uppsala University Hospital, Uppsala, Sweden; Department of Surgery, NU-Hospital Organization, Trollhättan, Sweden.
Source
Eur J Vasc Endovasc Surg. 2014 Jul;48(1):5-10
Date
Jul-2014
Language
English
Publication Type
Article
Keywords
Age Factors
Aged
Carotid Artery Diseases - epidemiology - ultrasonography
Carotid Stenosis - epidemiology - ultrasonography
Comorbidity
Coronary Artery Disease - epidemiology
Diabetes Mellitus - epidemiology
Humans
Hypertension - epidemiology
Logistic Models
Male
Mass Screening - methods
Multivariate Analysis
Odds Ratio
Predictive value of tests
Prevalence
Risk assessment
Risk factors
Severity of Illness Index
Sex Factors
Smoking - adverse effects - epidemiology
Sweden - epidemiology
Ultrasonography, Doppler, Duplex
Abstract
There are limited contemporary epidemiological data on the prevalence of carotid atherosclerosis in the general population. The aim was to determine the prevalence of and risk factors associated with carotid artery atherosclerosis among 65-year-old men.
This was a population-based screening study. All 65-year-old men in the County of Uppsala, Sweden, who attended screening for abdominal aortic aneurysm (AAA) 2007-2009, were invited for duplex scanning of the carotid arteries.
Of 4801 men invited, 4657 (97%) accepted. Carotid plaques (>2 × 6 mm) were observed in 1169 (25%) men, 94 (2.0%) had carotid stenoses (50-99%), and 15 (0.3%) had occluded carotid arteries. In a multivariate logistic regression model, smoking (OR 1.7, 95% CI 1.5-1.9), hypertension (1.5, 95% CI 1.3-1.7), diabetes mellitus (1.2, 95% CI 1.0-1.5), and coronary artery disease (1.5, 95% CI 1.3-1.8) were associated with prevalence of carotid atherosclerosis (plaque and/or stenosis). The use of antiplatelet agents and statins in participants with a carotid plaque was 20% and 29%, respectively. The corresponding figures in participants with a stenosis were 42% and 41%.
This study offers contemporary data on the prevalence of carotid atherosclerosis in a population-based cohort of 65-year-old men. Most of those at risk had no other clinical manifestation of atherosclerosis, and therefore had no secondary prevention.
Notes
Comment In: Eur J Vasc Endovasc Surg. 2014 Jul;48(1):11-224878233
PubMed ID
24631197 View in PubMed
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Screening for abdominal aortic aneurysm among patients referred to the vascular laboratory is cost-effective.

https://arctichealth.org/en/permalink/ahliterature98692
Source
Eur J Vasc Endovasc Surg. 2010 Feb;39(2):208-16
Publication Type
Article
Date
Feb-2010
Author
K. Mani
M. Alund
M. Björck
J. Lundkvist
A. Wanhainen
Author Affiliation
Department of Surgical Sciences, Section of Vascular Surgery, Uppsala University Hospital, SE-751 85 Uppsala, Sweden. kevin.mani@surgsci.uu.se
Source
Eur J Vasc Endovasc Surg. 2010 Feb;39(2):208-16
Date
Feb-2010
Language
English
Publication Type
Article
Keywords
Aged
Aortic Aneurysm, Abdominal - diagnosis - economics
Cost-Benefit Analysis - economics
Female
Hospitals, University
Humans
Male
Markov Chains
Mass Screening - economics
Referral and Consultation
Survival Rate
Sweden
Abstract
Screening for abdominal aortic aneurysm (AAA) in high-risk groups has been recommended based on a high prevalence of disease, while being questioned due to a high frequency of co-morbidities and inferior life-expectancy. We evaluated the long-term outcome and the cost-effectiveness of selective AAA screening among patients referred to the vascular laboratory for arterial examination. METHODS: A total of 5,924 patients, referred to the vascular laboratory of a university hospital, were screened for AAA with ultrasound (definition: slashed circle>or=30 mm), 1993-2005. Outcome data were gathered through hospital records and the national population registry. A Markov model was used for health-economic evaluation. RESULTS: An AAA was detected in 181 patients (mean age 72.8 years), of whom 21.5% underwent elective repair (perioperative mortality 5.1%) after 7.5 years of follow-up. Four of six patients diagnosed with AAA rupture were operated upon. Relative 5-year survival compared with the general Swedish population, controlled for age and sex, was 80.4% (95% confidence interval (CI): 70.8-88.8). The cost-effectiveness was robust in base-case (11,084 Euro/life year gained) and in sensitivity analyses of prevalence, cost and survival. CONCLUSIONS: Patients in whom AAA was detected at selective screening had inferior long-term survival and were operated on less frequently, compared with AAA patients described in previous studies. Yet, selective screening at the vascular laboratory was cost-effective.
PubMed ID
19942460 View in PubMed
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Early and long-term outcome after thoracic endovascular aortic repair (TEVAR) for acute complicated type B aortic dissection.

https://arctichealth.org/en/permalink/ahliterature138195
Source
Eur J Vasc Endovasc Surg. 2011 Mar;41(3):318-23
Publication Type
Article
Date
Mar-2011
Author
J. Steuer
M-O Eriksson
R. Nyman
M. Björck
A. Wanhainen
Author Affiliation
Institution of Surgical Sciences, Department of Vascular Surgery, Uppsala University, Sweden. johnny.steuer@akademiska.se
Source
Eur J Vasc Endovasc Surg. 2011 Mar;41(3):318-23
Date
Mar-2011
Language
English
Publication Type
Article
Keywords
Acute Disease
Adult
Aged
Aged, 80 and over
Aneurysm, Dissecting - mortality - radiography - surgery
Aortic Aneurysm, Thoracic - mortality - radiography - surgery
Aortography - methods
Blood Vessel Prosthesis Implantation - adverse effects - mortality
Endovascular Procedures - adverse effects - mortality
Female
Hospital Mortality
Humans
Kaplan-Meier Estimate
Male
Middle Aged
Paraplegia - etiology
Reoperation
Retrospective Studies
Stroke - etiology
Survival Rate
Sweden
Time Factors
Tomography, X-Ray Computed
Treatment Outcome
Abstract
The study aimed to investigate early and long-term outcome of thoracic endovascular aortic repair (TEVAR) for acute complicated type B dissection.
This was a retrospective, single-centre, consecutive case series.
During the period 1999-2009, TEVAR was carried out in 50 patients with non-traumatic acute complicated type B dissection, and in another 10 patients with acute complications, including rupture, end-organ ischaemia and acute dilatation during the primary hospitalisation, but >14 days after onset of symptoms. Thus, in total, 60 patients were included; 22 with a DeBakey type IIIa dissection and 38 with a type IIIb; median age was 67 years. Early (30-day) and long-term (5-year) survival, re-intervention rate and complications were recorded until 1 July 2010.
Within 30 days, two (3%) deaths, one (2%) paraplegia and three (5%) strokes were observed. Five-year survival was 87% and freedom from re-intervention at 5 years was 65%.
In patients with acute complicated type B aortic dissection, TEVAR can be performed with excellent early and long-term survival, whereas morbidity and long-term durability must be further elucidated.
PubMed ID
21194985 View in PubMed
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Endovascular Versus Open Repair as Primary Strategy for Ruptured Abdominal Aortic Aneurysm: A National Population-based Study.

https://arctichealth.org/en/permalink/ahliterature272524
Source
Eur J Vasc Endovasc Surg. 2016 Jan;51(1):22-8
Publication Type
Article
Date
Jan-2016
Author
K. Gunnarsson
A. Wanhainen
K. Djavani Gidlund
M. Björck
K. Mani
Source
Eur J Vasc Endovasc Surg. 2016 Jan;51(1):22-8
Date
Jan-2016
Language
English
Publication Type
Article
Keywords
Aged
Aged, 80 and over
Aortic Aneurysm, Abdominal - diagnosis - mortality - surgery
Aortic Rupture - diagnosis - mortality - surgery
Blood Vessel Prosthesis Implantation - adverse effects - mortality
Comorbidity
Endovascular Procedures - adverse effects - mortality
Female
Humans
Kaplan-Meier Estimate
Male
Middle Aged
Registries
Risk assessment
Risk factors
Sweden - epidemiology
Time Factors
Treatment Outcome
Abstract
In randomized trials, no peri-operative survival benefit has been shown for endovascular (EVAR) repair of ruptured abdominal aortic aneurysm (rAAA) when compared with open repair. The aim of this study was to investigate the effect of primary repair strategy on early and midterm survival in a non-selected population based study.
The Swedish Vascular Registry was consulted to identify all rAAA repairs performed in Sweden in the period 2008-12. Centers with a primary EVAR strategy (treating > 50% of rAAA with EVAR) were compared with centers with a primary open repair strategy. Peri-operative outcome, midterm survival, and incidence of rAAA repair/100,000 inhabitants aged > 50 years were assessed.
In total, 1,304 patients were identified. Three primary EVAR centers (pEVARc) operated on 236 patients (74.6% EVAR). Twenty-six primary open repair centers (pORc) operated 1,068 patients (15.6% EVAR). Patients treated at pEVARc were more often referrals (28.0% vs. 5.3%; p
Notes
Comment In: Eur J Vasc Endovasc Surg. 2016 Jan;51(1):2926520179
PubMed ID
26238308 View in PubMed
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Percutaneous closure of large femoral artery access with Prostar XL in thoracic endovascular aortic repair.

https://arctichealth.org/en/permalink/ahliterature107065
Source
Eur J Vasc Endovasc Surg. 2013 Nov;46(5):558-63
Publication Type
Article
Date
Nov-2013
Author
E. Skagius
M. Bosnjak
M. Björck
J. Steuer
R. Nyman
A. Wanhainen
Author Affiliation
Department of Surgical Sciences, Section of Vascular Surgery, Uppsala University, Uppsala, Sweden; Department of Surgery, Sundsvall County Hospital, Sundsvall, Sweden. Electronic address: elisabet.skagius@lvn.se.
Source
Eur J Vasc Endovasc Surg. 2013 Nov;46(5):558-63
Date
Nov-2013
Language
English
Publication Type
Article
Keywords
Adult
Aged
Aged, 80 and over
Aorta, Thoracic - radiography - surgery
Aortography - methods
Endovascular Procedures - adverse effects
Equipment Design
Female
Femoral Artery - radiography - surgery
Hemostatic Techniques - adverse effects - instrumentation
Hospitals, University
Humans
Male
Middle Aged
Postoperative Hemorrhage - etiology - prevention & control - radiography - surgery
Punctures
Registries
Reoperation
Retrospective Studies
Sweden
Time Factors
Tomography, X-Ray Computed
Treatment Outcome
Young Adult
Abstract
To investigate the technical success rate of Prostar XL for closure of large (=20F) femoral vascular access sites in thoracic endovascular aortic repair (TEVAR) procedures.
This was a single-center consecutive case series. All TEVAR procedures at Uppsala University Hospital 2006-2010 were registered prospectively. Reoperations and cases with open closure technique were excluded. Primary (early) technical failure was defined as closure failure requiring immediate (on-table) open surgical repair; late access-related complication occurred thereafter. The medical records, pre- and postoperative computed tomography images were reviewed retrospectively.
A total of 164 TEVAR procedures were identified, of which 118 (71%) had a median 22F (range 20-26F) access site sealed with tandem Prostar XL. The indications for TEVAR were dissection (47%), aneurysm (42%), trauma (8%), and miscellaneous (3%). Median follow-up time was 10 months (range 1-62). Primary technical failure occurred in 10 of 118 (8%). These cases were converted to cut-downs and surgical repair (n = 7), femoral fascia suturing (n = 2), and external compression with the Femo-Stop device (n = 1). Hypertension was associated with primary failure (p = .005), and a trend was observed for high age (p = .078) and increased groin subcutaneous fat layer (p = .077). Late access-related complications included pseudo-aneurysms (n = 12), small hematomas (n = 7), superficial groin infections (n = 2), and deep venous thrombosis (n = 1). None of the late complications required surgical treatment.
The access closure technique with tandem Prostar XL for large access sites during TEVAR is safe, in experienced hands. Few technical failures and few late complications occur, and they are usually benign.
Notes
Comment In: Eur J Vasc Endovasc Surg. 2013 Nov;46(5):56424064389
PubMed ID
24064388 View in PubMed
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17 records – page 1 of 2.