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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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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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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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Outcome After Ruptured AAA Repair in Octo- and Nonagenarians in Sweden 1994-2014.

https://arctichealth.org/en/permalink/ahliterature288287
Source
Eur J Vasc Endovasc Surg. 2017 May;53(5):656-662
Publication Type
Article
Date
May-2017
Author
B. Sonesson
K. Björses
N. Dias
R. Rylance
K. Mani
A. Wanhainen
T. Resch
Source
Eur J Vasc Endovasc Surg. 2017 May;53(5):656-662
Date
May-2017
Language
English
Publication Type
Article
Keywords
Age Factors
Aged, 80 and over
Aortic Aneurysm, Abdominal - diagnostic imaging - mortality - surgery
Aortic Rupture - diagnostic imaging - mortality - surgery
Blood Vessel Prosthesis Implantation - adverse effects - instrumentation - mortality
Chi-Square Distribution
Endovascular Procedures - adverse effects - instrumentation - mortality
Female
Humans
Kaplan-Meier Estimate
Male
Multivariate Analysis
Odds Ratio
Proportional Hazards Models
Registries
Retrospective Studies
Risk factors
Sweden
Time Factors
Treatment Outcome
Abstract
To report the outcome after ruptured abdominal aortic aneurysm (rAAA) repair in octo- and nonagenarians from the Swedish Vascular Registry 1994-2014.
2335 intact AAA (iAAA) and 1538 rAAA were identified in patients aged 80 years and older. Crude, long-term, and relative survival data were analysed using the Kaplan-Meier method. Crude survival was calculated including all deaths. Long-term survival was analysed excluding AAA repair related mortality, defined as death within 90 days of surgery. Relative survival was assessed by comparing the observed long-term survival after AAA repair with the expected survival of a Swedish population adjusted for age, gender, and operation year. Differences were compared using log-rank tests. The multivariate Cox model was used for adjusting for confounding factors between open repair (OR) and endovascular aneurysm repair (EVAR).
Crude survival after rAAA repair was 30 days (55%), 90 days (50%), 1 year (45%), 5 years (26%), and 10 years (9%). Long-term survival was 1 year (90%), 5 years (53%), and 10 years (18%). When individuals with rAAA were categorized into males and females, crude and long-term survival showed no significant differences (p = .204 and p = .134). When rAAA patients were categorized into age groups (80-84 years, 85-89 years, 90+) crude survival diminished with increasing age, but long-term survival was not (p = .009 and p = .368). Compared with the general population, rAAA patients showed only a minor decrease in relative survival. Crude survival after rAAA was better for EVAR compared with OR (p = .007), hazard ratio 1.3 (95% CI 1.1-1.6, p 
PubMed ID
28356210 View in PubMed
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Comparative analysis of the outcomes of elective abdominal aortic aneurysm repair in England and Sweden.

https://arctichealth.org/en/permalink/ahliterature296652
Source
Br J Surg. 2018 04; 105(5):520-528
Publication Type
Comparative Study
Journal Article
Multicenter Study
Research Support, Non-U.S. Gov't
Date
04-2018
Author
A Karthikesalingam
M J Grima
P J Holt
A Vidal-Diez
M M Thompson
A Wanhainen
M Bjorck
K Mani
Author Affiliation
St George's Vascular Institute, St George's University of London, London, UK.
Source
Br J Surg. 2018 04; 105(5):520-528
Date
04-2018
Language
English
Publication Type
Comparative Study
Journal Article
Multicenter Study
Research Support, Non-U.S. Gov't
Keywords
Age Factors
Aged
Aortic Aneurysm, Abdominal - mortality - surgery
Elective Surgical Procedures - methods
Endovascular Procedures - methods
England - epidemiology
Female
Follow-Up Studies
Hospital Mortality - trends
Humans
Male
Prognosis
Retrospective Studies
Risk factors
Sex Factors
Survival Rate - trends
Sweden - epidemiology
Time Factors
Treatment Outcome
Abstract
There is substantial international variation in mortality after abdominal aortic aneurysm (AAA) repair; many non-operative factors influence risk-adjusted outcomes. This study compared 90-day and 5-year mortality for patients undergoing elective AAA repair in England and Sweden.
Patients were identified from English Hospital Episode Statistics and the Swedish Vascular Registry between 2003 and 2012. Ninety-day mortality and 5-year survival were compared after adjustment for age and sex. Separate within-country analyses were performed to examine the impact of co-morbidity, hospital teaching status and hospital annual caseload.
The study included 36?249 patients who had AAA treatment in England, with a median age of 74 (i.q.r. 69-79) years, of whom 87·2 per cent were men. There were 7806 patients treated for AAA in Sweden, with a median of age 73 (68-78) years, of whom 82·9 per cent were men. Ninety-day mortality rates were poorer in England than in Sweden (5·0 versus 3·9 per cent respectively; P?
PubMed ID
29468657 View in PubMed
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Early sac shrinkage predicts a low risk of late complications after endovascular aortic aneurysm repair.

https://arctichealth.org/en/permalink/ahliterature104461
Source
Br J Surg. 2014 Jun;101(7):802-10
Publication Type
Article
Date
Jun-2014
Author
F. Bastos Gonçalves
H. Baderkhan
H J M Verhagen
A. Wanhainen
M. Björck
R J Stolker
S E Hoeks
K. Mani
Author Affiliation
Department of Vascular Surgery, Erasmus University Medical Centre, Rotterdam, The Netherlands; Department of Angiology and Vascular Surgery, Hospital de Santa Marta, Centro Hospitalar de Lisboa Central, Lisbon, Portugal.
Source
Br J Surg. 2014 Jun;101(7):802-10
Date
Jun-2014
Language
English
Publication Type
Article
Keywords
Aged
Analysis of Variance
Aortic Aneurysm, Abdominal - pathology - radiography - surgery - ultrasonography
Aortic Rupture - pathology - surgery
Chi-Square Distribution
Endoleak - epidemiology - etiology
Endovascular Procedures - adverse effects - methods
Female
Humans
Male
Netherlands
Organ Size
Reoperation - statistics & numerical data
Sweden
Abstract
Aneurysm shrinkage has been proposed as a marker of successful endovascular aneurysm repair (EVAR). Patients with early postoperative shrinkage may experience fewer subsequent complications, and consequently require less intensive surveillance.
Patients undergoing EVAR from 2000 to 2011 at three vascular centres (in 2 countries), who had two imaging examinations (postoperative and after 6-18 months), were included. Maximum diameter, complications and secondary interventions during follow-up were registered. Patients were categorized according to early sac dynamics. The primary endpoint was freedom from late complications. Secondary endpoints were freedom from secondary intervention, postimplant rupture and direct (type I/III) endoleaks.
Some 597 EVARs (71.1 per cent of all EVARs) were included. No shrinkage was observed in 284 patients (47.6 per cent), moderate shrinkage (5-9 mm) in 142 (23.8 per cent) and major shrinkage (at least 10 mm) in 171 patients (28.6 per cent). Four years after the index imaging, the rate of freedom from complications was 84.3 (95 per cent confidence interval 78.7 to 89.8), 88.1 (80.6 to 95.5) and 94.4 (90.1 to 98.7) per cent respectively. No shrinkage was an independent risk factor for late complications compared with major shrinkage (hazard ratio (HR) 3.11; P
PubMed ID
24752772 View in PubMed
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Treatment of Abdominal Aortic Aneurysm in Nine Countries 2005-2009: A Vascunet Report.

https://arctichealth.org/en/permalink/ahliterature101427
Source
Eur J Vasc Endovasc Surg. 2011 Jul 18;
Publication Type
Article
Date
Jul-18-2011
Author
K. Mani
T. Lees
B. Beiles
L P Jensen
M. Venermo
G. Simo
D. Palombo
E. Halbakken
T. Troëng
P. Wigger
M. Björck
Author Affiliation
Department of Vascular Surgery, Guy's and St Thomas' NHS Foundation Trust, London, UK; Department of Surgical Sciences, Section of Vascular Surgery, Uppsala University, Uppsala, Sweden.
Source
Eur J Vasc Endovasc Surg. 2011 Jul 18;
Date
Jul-18-2011
Language
English
Publication Type
Article
Abstract
OBJECTIVES: To study contemporary treatment and outcome of abdominal aortic aneurysm (AAA) repair in nine countries. DESIGN AND METHODS: Data on primary AAA repairs 2005-2009 were amalgamated from national and regional vascular registries in Australia, Denmark, Finland, Hungary, Italy, Norway, Sweden, Switzerland and the UK. Primary outcome was in-hospital or 30-day mortality. Multivariate logistic regression was used to assess case-mix. RESULTS: 31,427 intact AAA repairs were identified, mean age 72.6 years (95% CI 72.5-72.7). The rate of octogenarians and use of endovascular repair (EVAR) increased over time (p 
PubMed ID
21775173 View in PubMed
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Comparison of long-term mortality after ruptured abdominal aortic aneurysm in England and Sweden.

https://arctichealth.org/en/permalink/ahliterature273139
Source
Br J Surg. 2016 Feb;103(3):199-206
Publication Type
Article
Date
Feb-2016
Author
A. Karthikesalingam
A. Wanhainen
P J Holt
A. Vidal-Diez
J R W Brownrigg
I. Shpitser
M. Björck
M M Thompson
K. Mani
Source
Br J Surg. 2016 Feb;103(3):199-206
Date
Feb-2016
Language
English
Publication Type
Article
Keywords
Aged
Aged, 80 and over
Aortic Aneurysm, Abdominal - mortality - surgery
Aortic Rupture - mortality - surgery
Endovascular Procedures - methods
England - epidemiology
Female
Follow-Up Studies
Hospital Mortality - trends
Humans
Male
Prognosis
Retrospective Studies
Sweden - epidemiology
Time Factors
Abstract
Concern has been raised regarding international discrepancies in perioperative mortality after repair of ruptured abdominal aortic aneurysm (rAAA). The variation in in-hospital mortality is difficult to interpret, owing to international differences in discharge strategies. This study compared 90-day and 5-year mortality in patients who had a rAAA in England and Sweden.
Patients undergoing rAAA repair were identified from English Hospital Episode Statistics and the Swedish Vascular Registry (Swedvasc) between 2003 and 2012. Ninety-day and 5-year mortality were compared after matching for age and sex. Within-country analyses examined the impact of co-morbidity, teaching hospital status or hospital annual caseload, adjusted with causal inference techniques.
Some 12 467 patients underwent rAAA repair in England, of whom 83.2 per cent were men; the median (i.q.r.) age was 75 (70-80) years. A total of 2829 Swedish patients underwent rAAA repair, of whom 81.3 per cent were men; their median (i.q.r.) age was 75 (69-80) years. The 90-day mortality rate was worse in England (44.0 per cent versus 33.4 per cent in Sweden; P
PubMed ID
26620854 View in PubMed
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Homozygosity mapping to the USH2A locus in two isolated populations.

https://arctichealth.org/en/permalink/ahliterature203036
Source
J Med Genet. 1999 Feb;36(2):144-7
Publication Type
Article
Date
Feb-1999
Author
T. Fagerheim
P. Raeymaekers
J. Merren
K. Mani
G K Jha
L. Baumbach
V. Brox
E. Breines
B E Holdø
A. Holdø
L. Tranebjaerg
Author Affiliation
Department of Medical Genetics, Regional Hospital of Tromsø, Norway.
Source
J Med Genet. 1999 Feb;36(2):144-7
Date
Feb-1999
Language
English
Publication Type
Article
Keywords
Chromosomes, Human, Pair 1 - genetics
Extracellular Matrix Proteins - genetics
Female
Hearing Loss, Sensorineural - genetics
Homozygote
Humans
Lod Score
Male
Microsatellite Repeats
Norway
Pedigree
Retinitis Pigmentosa - genetics
Syndrome
West Indies
Abstract
Usher syndrome is a group of autosomal recessive disorders characterised by progressive visual loss from retinitis pigmentosa and moderate to severe sensorineural hearing loss. Usher syndrome is estimated to account for 6-10% of all congenital sensorineural hearing loss. A gene locus in Usher type II (USH2) families has been assigned to a small region on chromosome 1q41 called the UHS2A locus. We have investigated two families with Usher syndrome from different isolated populations. One family is a Norwegian Saami family and the second family is from the Cayman Islands. They both come from relatively isolated populations and are inbred families suitable for linkage analysis. A lod score of 3.09 and 7.65 at zero recombination was reached respectively in the two families with two point linkage analysis to the USH2A locus on 1q41. Additional homozygosity mapping of the affected subjects concluded with a candidate region of 6.1 Mb. This region spans the previously published candidate region in USH2A. Our study emphasises that the mapped gene for USH2 is also involved in patients from other populations and will have implications for future mutation analysis once the USH2A gene is cloned.
PubMed ID
10051015 View in PubMed
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10 records – page 1 of 1.