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Age at detection of abdominal aortic aneurysms in siblings of patients with abdominal aortic aneurysms.

https://arctichealth.org/en/permalink/ahliterature275171
Source
J Vasc Surg. 2016 Apr;63(4):883-7
Publication Type
Article
Date
Apr-2016
Author
Anneli Linné
Johan Forsberg
David Lindström
Ester Ideskog
Rebecka Hultgren
Source
J Vasc Surg. 2016 Apr;63(4):883-7
Date
Apr-2016
Language
English
Publication Type
Article
Keywords
Adult
Age Factors
Aged
Aged, 80 and over
Aorta, Abdominal - ultrasonography
Aortic Aneurysm, Abdominal - epidemiology - genetics - ultrasonography
Dilatation, Pathologic
Female
Genetic Predisposition to Disease
Heredity
Humans
Male
Mass Screening - methods
Middle Aged
Pedigree
Phenotype
Predictive value of tests
Prevalence
Risk assessment
Risk factors
Sex Factors
Siblings
Sweden - epidemiology
Abstract
Few countries offer organized screening of siblings of patients with abdominal aortic aneurysms (AAAs), although a hereditary trait is well known to exist. Male relatives, but not female, are invited within the population-based screening programs for elderly men in Sweden. Evidence regarding the optimal age to screen siblings is scarce. The aim of this study was to describe the age at detection in siblings found with AAAs.
All patients treated for AAAs in two Swedish counties were screened for siblings. Consenting siblings aged 80 and younger were examined (N = 529) with ultrasound and were interviewed per protocol.
In the cohort of 529 siblings to AAA patients, 53 siblings were diagnosed with AAAs (sisters 16/276 [5.8%] and brothers 37/253 [14.6%]). The prevalence of AAAs in the siblings 65 years of age or younger was 16/207 (7.7%). One-third of the siblings found with AAAs were young (16/53 [30%]). Among the young siblings with AAAs, 8/16 (50%) had an aneurysm larger than 50 mm or were already surgically treated. The prevalence of AAAs in siblings older than 65 years of age was 37/322 (12%).
The AAA prevalence in this sibling cohort is strikingly high compared to the prevalence in the population (in Sweden, 1.4%-2.2% in 65-year-old men). The young ages among diagnosed siblings reinforce that male siblings of AAA patients should be screened before age 65 (before the population-based program) and that structured programs for female siblings are called for.
PubMed ID
26826057 View in PubMed
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Cost-effectiveness of intensive smoking cessation therapy among patients with small abdominal aortic aneurysms.

https://arctichealth.org/en/permalink/ahliterature134114
Source
J Vasc Surg. 2011 Sep;54(3):628-36
Publication Type
Article
Date
Sep-2011
Author
Kevin Mani
Anders Wanhainen
Jonas Lundkvist
David Lindström
Author Affiliation
Department of Surgical Sciences, Section of Vascular Surgery, Uppsala University, Uppsala, Sweden. kevin.mani@surgsci.uu.se
Source
J Vasc Surg. 2011 Sep;54(3):628-36
Date
Sep-2011
Language
English
Publication Type
Article
Keywords
Aged
Aortic Aneurysm, Abdominal - diagnosis - economics - etiology - therapy
Aortic Rupture - economics - etiology - prevention & control
Computer simulation
Cost-Benefit Analysis
Disease Progression
Health Care Costs
Humans
Male
Markov Chains
Mass Screening - economics
Models, Economic
Predictive value of tests
Prognosis
Quality-Adjusted Life Years
Registries
Risk assessment
Risk factors
Smoking - adverse effects - economics
Smoking Cessation - economics
Sweden
Time Factors
Abstract
Smoking cessation is one of the few available strategies to decrease the risk for expansion and rupture of small abdominal aortic aneurysms (AAAs). The cost-effectiveness of an intensive smoking cessation therapy in patients with small AAAs identified at screening was evaluated.
A Markov cohort simulation model was used to compare an 8-week smoking cessation intervention with adjuvant pharmacotherapy and annual revisits vs nonintervention among 65-year-old male smokers with a small AAA identified at screening. The smoking cessation rate was tested in one-way sensitivity analyses in the intervention group (range, 22%-57%) and in the nonintervention group (range, 3%-30%). Literature data on the effect of smoking on AAA expansion and rupture was factored into the model.
The intervention was cost-effective in all tested scenarios and sensitivity analyses. The smoking cessation intervention was cost-effective due to a decreased need for AAA repair and decreased rupture rate even when disregarding the positive effects of smoking cessation on long-term survival. The incremental cost/effectiveness ratio reached the willingness-to-pay threshold value of €25,000 per life-year gained when assuming an intervention cost of > €3250 or an effect of = 1% difference in long-term smoking cessation between the intervention and nonintervention groups. Smoking cessation resulted in a relative risk reduction for elective AAA repair by 9% and for rupture by 38% over 10 years of follow-up.
An adequate smoking cessation intervention in patients with small AAAs identified at screening can cost-effectively increase long-term survival and decrease the need for AAA repair.
PubMed ID
21620630 View in PubMed
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High prevalence of abdominal aortic aneurysms in brothers and sisters of patients despite a low prevalence in the population.

https://arctichealth.org/en/permalink/ahliterature126085
Source
J Vasc Surg. 2012 Aug;56(2):305-10
Publication Type
Article
Date
Aug-2012
Author
Anneli Linné
David Lindström
Rebecka Hultgren
Author Affiliation
Department of Clinical Science and Education, Karolinska Institutet, Stockholm, Sweden. anneli.linne@sodersjukhuset.se
Source
J Vasc Surg. 2012 Aug;56(2):305-10
Date
Aug-2012
Language
English
Publication Type
Article
Keywords
Aged
Aortic Aneurysm, Abdominal - epidemiology - genetics - ultrasonography
Female
Humans
Male
Mass Screening
Middle Aged
Prevalence
Risk factors
Siblings
Smoking - epidemiology
Sweden - epidemiology
Abstract
Population-based screening for abdominal aortic aneurysms (AAAs) in elderly men is organized in many regions and countries in the Western world, and the prevalence of disease is reported to decline. Whether the prevalence among those with a family history also is declining is unknown. The primary purpose of this study was to assess the prevalence of AAAs among siblings of persons with AAAs and to investigate the proportion of siblings already diagnosed by opportunistic screening.
Patients treated for AAAs from January 2008 through December 2010 (n = 412) in Stockholm, Sweden, were screened for siblings. Seven hundred seventy-nine siblings were identified. All siblings 65 (odds ratio, 10.8; 95% confidence interval, 1.3-86.4; P = .03). Ever smoking was not statistically significant as a risk.
A strikingly high prevalence of AAAs in siblings was found as compared to the reported declining aneurysm prevalence in elderly men in the Western world. Systematic improvements regarding screening of first-degree relatives is mandated and selective screening of siblings is an underused tool to prevent death from aneurysm disease, both among men and women.
PubMed ID
22425245 View in PubMed
Less detail

Outcome after nitinol stenting in the superficial femoral and popliteal artery in an elderly population.

https://arctichealth.org/en/permalink/ahliterature135867
Source
Ann Vasc Surg. 2011 Aug;25(6):758-65
Publication Type
Article
Date
Aug-2011
Author
Peter Gillgren
Hans Pettersson
Johan Fernström
Mårten Falkenberg
Martin Delle
Peter Konrad
David Lindström
Author Affiliation
Vascular Surgery Section, Department of Clinical Science and Education, Karolinska Institute, Stockholm, Sweden. peter.gillgren@sodersjukhuset.se
Source
Ann Vasc Surg. 2011 Aug;25(6):758-65
Date
Aug-2011
Language
English
Publication Type
Article
Keywords
Age Factors
Aged
Aged, 80 and over
Alloys
Angioplasty - adverse effects - instrumentation - mortality
Arterial Occlusive Diseases - mortality - therapy - ultrasonography
Chi-Square Distribution
Female
Femoral Artery - physiopathology - ultrasonography
Humans
Ischemia - mortality - therapy - ultrasonography
Kaplan-Meier Estimate
Limb Salvage
Male
Popliteal Artery - physiopathology - ultrasonography
Proportional Hazards Models
Prosthesis Design
Recurrence
Registries
Retrospective Studies
Risk assessment
Risk factors
Stents
Sweden
Time Factors
Treatment Outcome
Ultrasonography, Doppler, Duplex
Vascular Patency
Abstract
To assess outcomes in an elderly and diseased population after stenting in the femoropopliteal segment and evaluate risk factors for poor prognosis.
Retrospective study of femoropopliteal stents placed between March 2006 and January 2008. Patency was verified by duplex scanning. Risk factors associated with amputation or death and patency were analyzed using Cox regression.
A total of 117 limbs in 112 patients were observed for a median of 18 months. Median age of the patients was 79 years; 68% were treated for critical limb ischemia and 85% had occlusive lesions. Mean lesion length was 15.4 cm (SD: 9.2) and mean stented length was 19.7 cm (standard deviation: 9.8). At 1 year, primary patency was 63%, primary-assisted patency was 67%, and secondary patency was 69%. Stent diameter =6 versus 7 mm was a risk factor for loss of patency with a hazard ratio (HR) of 2.9 (95% CI: 1.1-7.7). Significant risk factors for death or amputation were as follows: HR for rest pain versus claudication was 5.9 (1.1-32.8), HR for tissue loss versus claudication was 5.8 (1.1-29.6), HR for stent diameter =6 versus 7 mm was 3.6 (1.0-12.3), and HR for 3-4 stents versus 1-2 was 2.6 (1.1-6.1).
Rutherford status is associated with death or amputation after stenting in the femoropopliteal segment. In addition, a smaller stent diameter and number of stents depict poorer prognosis independent of gender and anatomic level.
PubMed ID
21439769 View in PubMed
Less detail