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Academic vascular unit collaboration with advertising agency yields higher compliance in screening for abdominal aortic aneurysm.

https://arctichealth.org/en/permalink/ahliterature263583
Source
J Med Screen. 2014 Dec;21(4):216-8
Publication Type
Article
Date
Dec-2014
Author
Moncef Zarrouk
Anders Gottsäter
Martin Malina
Jan Holst
Source
J Med Screen. 2014 Dec;21(4):216-8
Date
Dec-2014
Language
English
Publication Type
Article
Keywords
Advertising as Topic - economics
Aortic Aneurysm, Abdominal - ultrasonography
Cooperative Behavior
Hospitals, University
Humans
Odds Ratio
Patient compliance
Sweden
Abstract
To improve compliance with abdominal aortic aneurysm (AAA) screening in low compliance areas, individually tailored invitations were developed in collaboration with a professional advertising agency. Compliance increased in two intervention municipalities from 71.4% in 2010-2012 to 78.1% in 2013 (p?=?0.025), and was then higher [odds ratio 1.7; 95% confidence interval 1.1-2.6; p?=?0.013] than in two control municipalities in which compliance was unchanged (417/552 [75.5%] in 2010-12 and 122/180 [67.8%] in 2013). Compliance with AAA-screening can be increased by collaboration with a professional advertising agency, albeit at a comparably high cost.
PubMed ID
25118161 View in PubMed
Less detail

Efficacy and durability of the chimney graft technique in urgent and complex thoracic endovascular aortic repair.

https://arctichealth.org/en/permalink/ahliterature263150
Source
J Vasc Surg. 2015 Apr;61(4):886-94.e1
Publication Type
Article
Date
Apr-2015
Author
Adel Bin Jabr
Bengt Lindblad
Nuno Dias
Timothy Resch
Martin Malina
Source
J Vasc Surg. 2015 Apr;61(4):886-94.e1
Date
Apr-2015
Language
English
Publication Type
Article
Keywords
Aged
Aorta, Thoracic - surgery
Aortic Diseases - diagnosis - mortality - surgery
Aortography - methods
Blood Vessel Prosthesis
Blood Vessel Prosthesis Implantation - adverse effects - instrumentation - mortality
Endovascular Procedures - adverse effects - instrumentation - mortality
Female
Humans
Kaplan-Meier Estimate
Male
Middle Aged
Postoperative Complications - mortality - therapy
Prosthesis Design
Retrospective Studies
Risk factors
Stents
Sweden
Time Factors
Tomography, X-Ray Computed
Treatment Outcome
Abstract
This study reports the early and midterm to long-term experience of chimney grafts (CGs) in urgent endovascular repair of complex lesions in the thoracic aorta.
Twenty-nine high-risk patients (20 men) who were unfit for open repair were treated using CG technique for ruptured (n = 14) or symptomatic (n = 15) aortic lesions engaging the aortic arch itself (n = 9), the descending aorta (n = 10), or the thoracoabdominal aorta (n = 10). Twenty-two patients (76%) were treated urgently (=24 hours) and seven were semiurgent (=3 days). Of 41 chimneys used, 24 were placed in supra-aortic branches and 17 in visceral branches. Median follow-up (interquartile range) for the entire cohort was 2 years (0.6-3.8 years), 2.5 years (1-4 years) for 30-day survivors, and 3.5 years (1.9-6.4 years) for those who were still alive.
Four patients (14%) died =30 days of cerebral infarction (n = 1), visceral ischemia secondary to the initial rupture (n = 1), multiple organ failure (n = 1), or heart failure (n = 1). There were 11 late deaths (38%); however, only two deaths were related to the CG technique. The primary and secondary technical success rates were 86% (25 of 29) and 97% (28 of 29), respectively. The secondary patency rate of CGs was 98%. Seventeen (68%) of the aortic lesions shrank significantly. Three patients (10%) had primary type I endoleak and another three (10%) had secondary type I endoleak. The endoleaks were managed with Onyx (ev3 Endovascular, Inc, Plymouth, Minn) or coil embolization (n = 2), restenting (n = 1), and conversion to open repair (n = 2). One secondary endoleak is still under observation after >20 months. All primary endoleaks and one secondary endoleak originated from CGs in the brachiocephalic trunk (4 of 6 [67%]).
The midterm to long-term results of the CG technique for urgent and complex lesions of the thoracic aorta in high-risk patients are promising, with low early mortality and long durability of the CGs. More patients with longer follow-up are still needed.
PubMed ID
25616907 View in PubMed
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Outcomes of fenestrated endovascular repair of juxtarenal aortic aneurysm.

https://arctichealth.org/en/permalink/ahliterature107411
Source
J Vasc Surg. 2014 Jan;59(1):115-20
Publication Type
Article
Date
Jan-2014
Author
Thorarinn Kristmundsson
Björn Sonesson
Nuno Dias
Per Törnqvist
Martin Malina
Timothy Resch
Author Affiliation
Vascular Center, Skåne University Hospital, Malmö, Sweden. Electronic address: thorark@hotmail.com.
Source
J Vasc Surg. 2014 Jan;59(1):115-20
Date
Jan-2014
Language
English
Publication Type
Article
Keywords
Aged
Aortic Aneurysm, Abdominal - mortality - radiography - surgery
Aortography - methods
Blood Vessel Prosthesis
Blood Vessel Prosthesis Implantation - adverse effects - instrumentation - mortality
Endovascular Procedures - adverse effects - instrumentation - mortality
Female
Follow-Up Studies
Humans
Kaplan-Meier Estimate
Male
Postoperative Complications - mortality - physiopathology - therapy
Risk factors
Stents
Sweden
Tertiary Care Centers
Time Factors
Tomography, Spiral Computed
Treatment Outcome
Vascular Patency
Abstract
To evaluate late outcomes after fenestrated endovascular aortic repair (f-EVAR) in a tertiary European referral center.
In 2009, we published short- and midterm results after f-EVAR in the first 54 patients treated with this technique at our center between September 2002 and June 2007. In this paper, we provide long-term follow-up of the same patient cohort with the main focus on target vessel (TV) patency, renal function, reinterventions, and survival.
A total of 54 patients were included in this study. Median age was 72 years (interquartile range [IQR], 68-76 years) at primary operation, and 85% were men. Median preoperative aneurysm diameter was 60 mm (IQR, 53-66 mm). One hundred thirty-four vessels were targeted (mean, 2.5 per patient), and 96 TV stents were placed. The median clinical follow-up was 67 months (IQR, 37-90 months), and computed tomography follow-up was 60 months (IQR, 35-72 months). Aneurysm diameter decreased = 5 mm in 39% ± 7% at 12 months, 64% ± 8% at 36 months, and 71% ± 8% at 60 months. Primary TV patency was 94% ± 2% at 12 months, 91% ± 3% at 36 months, and 90% ± 3% at 60 months. Glomerular filtration rate decreased by 17% at 59 months (IQR, 26-73 months) follow-up (60 [IQR, 46-79] vs 50 [IQR, 38-72] mL/min/1.73 m(2); P
PubMed ID
24011738 View in PubMed
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Outcome of visceral chimney grafts after urgent endovascular repair of complex aortic lesions.

https://arctichealth.org/en/permalink/ahliterature274258
Source
J Vasc Surg. 2016 Mar;63(3):625-33
Publication Type
Article
Date
Mar-2016
Author
Adel Bin Jabr
Bengt Lindblad
Thorarinn Kristmundsson
Nuno Dias
Timothy Resch
Martin Malina
Source
J Vasc Surg. 2016 Mar;63(3):625-33
Date
Mar-2016
Language
English
Publication Type
Article
Keywords
Aged
Aged, 80 and over
Aorta, Abdominal - physiopathology - radiography - surgery
Aortic Aneurysm, Abdominal - diagnosis - mortality - physiopathology - surgery
Aortography - methods
Blood Vessel Prosthesis
Blood Vessel Prosthesis Implantation - adverse effects - instrumentation - mortality
Cause of Death
Emergencies
Endovascular Procedures - adverse effects - instrumentation - mortality
Female
Humans
Kaplan-Meier Estimate
Male
Postoperative Complications - mortality - therapy
Prosthesis Design
Retreatment
Retrospective Studies
Risk factors
Stents
Sweden
Time Factors
Tomography, X-Ray Computed
Treatment Outcome
Vascular Patency
Abstract
Endovascular abdominal aortic repair requires an adequate sealing zone. The chimney graft (CG) technique may be the only option for urgent high-risk patients who are unfit for open repair and have no adequate sealing zone. This single-center experience provides long-term results of CGs with endovascular repair for urgent and complex aortic lesions.
Between July 2006 and October 2012, 51 patients (16 women) with a median age of 77 years (interquartile range, 72-81 years), were treated urgently (within 24 hours [61%]) or semiurgently (within 3 days [39%]) with endovascular aortic repair and visceral CGs (n = 73). Median follow-up was 2.3 years (interquartile range, 0.8-5.0 years) for the whole cohort, 3 years for 30-day survivors, and 4.8 years for patients who are still alive.
Five patients (10%) died within 30 days. All of them had a sacrificed kidney. All-cause mortality was 57% (n = 29), but the chimney- and procedure-related mortality was 6% (n = 3) and 16% (n = 8), respectively. Chimney-related death was due to bleeding, infection, renal failure, and multiple organ failure. There were two postoperative ruptures; both were fatal although not related to the treated disease. The primary and secondary long-term CG patencies were 89% (65 of 73) and 93% (68 of 73), respectively. Primary type I endoleak (EL-I) occurred in 10% (5 of 51) of the patients, and only one patient had recurrent EL-I (2%; 1 of 51). No secondary endoleak was observed. Chimney-related reintervention was required in 16% (8 of 51) of the patients because of EL-I (n = 3), visceral ischemia (n = 4), and bleeding (n = 2). The reinterventions included stenting (n = 5), embolization (n = 3), and laparotomy (n = 2). Thirty-one visceral branches were sacrificed (9 celiac trunks, 9 right, and 13 left renal arteries). Among the 30-day survivors, 8 of 17 patients (47%) with a sacrificed kidney required permanent dialysis; of these, seven underwent an urgent index operation. The aneurysm sac shrank in 63% (29 of 46) of cases.
The 6% chimney-related mortality and 93% long-term patency seem promising in urgent, complex aortic lesions of a high-risk population and may justify a continued yet restrictive applicability of this technique. Most endoleaks could be sealed endovascularly. However, sacrifice of a kidney in this elderly cohort was associated with permanent dialysis in 47% of patients.
PubMed ID
26527423 View in PubMed
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Intra-aneurysm sac pressure measurements after endovascular aneurysm repair: differences between shrinking, unchanged, and expanding aneurysms with and without endoleaks.

https://arctichealth.org/en/permalink/ahliterature179716
Source
J Vasc Surg. 2004 Jun;39(6):1229-35
Publication Type
Article
Date
Jun-2004
Author
Nuno V Dias
Krassi Ivancev
Martin Malina
Timothy Resch
Bengt Lindblad
Björn Sonesson
Author Affiliation
Endovascular Center, Department of Radiology, UMAS, Malmö University Hospital, S-205 02 Malmö, Sweden. nunovdias@hotmail.com
Source
J Vasc Surg. 2004 Jun;39(6):1229-35
Date
Jun-2004
Language
English
Publication Type
Article
Keywords
Aged
Aged, 80 and over
Aortic Aneurysm, Abdominal - physiopathology - radiography - surgery
Blood Pressure - physiology
Blood Pressure Determination
Diastole - physiology
Embolization, Therapeutic
Female
Follow-Up Studies
Humans
Male
Middle Aged
Postoperative Complications - etiology - physiopathology - therapy
Reoperation
Sweden
Systole - physiology
Tomography, X-Ray Computed
Treatment Outcome
Vascular Surgical Procedures
Abstract
Our objective was to study intra-aneurysm pressure after endovascular aneurysm repair (EVAR) in shrinking, unchanged, and expanding abdominal aortic aneurysms (AAAs) with and without endoleaks.
Direct intra-aneurysm sac pressure measurement (DISP) by percutaneous translumbar puncture of the AAA under fluoroscopic guidance was performed 46 times during the follow-up of 37 patients (30 men; median age, 73 years [range, 58-82 years]; AAA diameter: median, 60 mm [range, 48-84 mm]). Three patients were included in two different groups because DISP was performed more than once with different indications. Tip-pressure sensors mounted on 0.014-inch guidewires were used for simultaneous measurement of systemic and AAA sac pressures. Mean pressure index (MPI) was calculated as the percentage of mean intra-aneurysm pressure relative to the simultaneous mean intra-aortic pressure.
Median MPI was 19% in shrinking (11 patients), 30% in unchanged (10 patients), and 59% in expanding (9 patients) aneurysms without endoleaks. Pulse pressure was also higher in expanding (10 mm Hg) compared with shrinking (2 mm Hg; P
PubMed ID
15192561 View in PubMed
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Impact of intrasac thrombus and a patent inferior mesenteric artery on EVAR outcome.

https://arctichealth.org/en/permalink/ahliterature141765
Source
J Endovasc Ther. 2010 Aug;17(4):534-9
Publication Type
Article
Date
Aug-2010
Author
Satoko Fujita
Timothy A Resch
Thorarinn Kristmundsson
Björn Sonesson
Bengt Lindblad
Martin Malina
Author Affiliation
Vascular Center Malmö-Lund, Malmö University Hospital, Malmö, Sweden. s-fujita.srg1@tmd.ac.jp
Source
J Endovasc Ther. 2010 Aug;17(4):534-9
Date
Aug-2010
Language
English
Publication Type
Article
Keywords
Aged
Aged, 80 and over
Aortic Aneurysm, Abdominal - complications - physiopathology - radiography - surgery
Aortography - methods
Blood Vessel Prosthesis
Blood Vessel Prosthesis Implantation - adverse effects - instrumentation
Databases as Topic
Embolization, Therapeutic
Female
Humans
Male
Mesenteric Artery, Inferior - physiopathology - radiography
Middle Aged
Prospective Studies
Prosthesis Design
Prosthesis Failure
Reoperation
Stents
Sweden
Thrombosis - complications - radiography
Time Factors
Tomography, Spiral Computed
Treatment Outcome
Vascular Patency
Abstract
To assess the significance of a patent inferior mesenteric artery (IMA) and presence of intrasac thrombus on the outcome of endovascular aneurysm repair (EVAR) for infrarenal abdominal aortic aneurysm (AAA).
Between June 2004 and June 2007, 114 AAA patients (100 men; mean age 75 years, range 56-87) treated electively with a bifurcated stent-graft were assessed with computed tomography pre- and postoperatively. Incidences of type II endoleaks and reinterventions were compared with preoperative intrasac thrombus and IMA patency.
Over a mean follow-up of 19 months (range 6-38), there was no aneurysm rupture. Eleven (11%) of 101 patients with and 7 (54%) of 13 patients without preoperative intrasac thrombus presented with a type II endoleak (p
PubMed ID
20681772 View in PubMed
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The importance of socioeconomic factors for compliance and outcome at screening for abdominal aortic aneurysm in 65-year-old men.

https://arctichealth.org/en/permalink/ahliterature115114
Source
J Vasc Surg. 2013 Jul;58(1):50-5
Publication Type
Article
Date
Jul-2013
Author
Moncef Zarrouk
Jan Holst
Martin Malina
Bengt Lindblad
Christine Wann-Hansson
Maria Rosvall
Anders Gottsäter
Author Affiliation
Department of Vascular Diseases, Skåne University Hospital, Malmö, Sweden. moncef.zarrouk@med.lu.se
Source
J Vasc Surg. 2013 Jul;58(1):50-5
Date
Jul-2013
Language
English
Publication Type
Article
Keywords
Age Factors
Aged
Aortic Aneurysm, Abdominal - epidemiology - ultrasonography
Cross-Sectional Studies
Emigrants and Immigrants
Humans
Income
Logistic Models
Male
Mass Screening - methods - statistics & numerical data
Multivariate Analysis
Patient Compliance - statistics & numerical data
Predictive value of tests
Prevalence
Residence Characteristics
Risk factors
Sex Factors
Smoking - epidemiology
Socioeconomic Factors
Sweden - epidemiology
Unemployment
Abstract
To evaluate compliance with screening and prevalence of abdominal aortic aneurysm (AAA) in relation to background data regarding area-based socioeconomic status.
Our department annually invites 4300 65-year-old men from the city of Malmö and 15 neighboring municipalities to ultrasound AAA screening. In a cross-sectional cohort study, compliance and AAA prevalence among 8269 men were related to background socioeconomic data such as mean income, proportion of immigrants, percentage of subjects on welfare, smoking habits, and unemployment rate in the different municipalities. The 10 different administrative areas in Malmö were evaluated separately.
Compliance with screening in the entire area was 6630/8269 (80.2%) but varied between 64.4% and 89.3% in different municipalities (P
PubMed ID
23541548 View in PubMed
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On the complexity of screening detected abdominal aortic aneurysms: a retrospective observational multicenter cohort study.

https://arctichealth.org/en/permalink/ahliterature285747
Source
Int Angiol. 2017 Jun;36(3):261-267
Publication Type
Article
Date
Jun-2017
Author
Håkan Ohlsson
Anders Gottsäter
Tim Resch
Björn Sonesson
Martin Malina
Per Kjellin
Tomas Wetterling
Jan Holst
Source
Int Angiol. 2017 Jun;36(3):261-267
Date
Jun-2017
Language
English
Publication Type
Article
Keywords
Age Factors
Aged
Aged, 80 and over
Aortic Aneurysm, Abdominal - diagnostic imaging - epidemiology - surgery
Computed Tomography Angiography
Endovascular Procedures
Humans
Male
Mass Screening
Retrospective Studies
Risk factors
Sex Factors
Sweden - epidemiology
Treatment Outcome
Ultrasonography
Abstract
Ultrasound screening for abdominal aortic aneurysms (AAA) has been shown to decrease aneurysm related mortality. Likely by providing an opportunity to intervene while the aneurysm is still intact, but possibly also when and the anatomy still relatively uncomplicated which would provide a less complex procedure. Our aim was to retrospectively investigate the complexity of repair for screening-detected AAAs in a cohort of 65-year-old men.
All screening detected AAA cases that underwent repair between Sept 2010 and June 2014 in the most southern region of Sweden were included. Procedures were classified as either standard or complex. A standard procedure was defined as either standard EVAR (endovascular aneurysm repair) within the manufacturers Instructions For Use (IFU) or open repair with infrarenal clamping followed by a tube graft repair. All other types of procedures were defined as complex. The prevalence rate of AAA, screening compliance, short- and midterm outcome of the operations were reported.
From the 35513 men invited to screening, 27 951 (78.7%) attended screening with ultrasound. AAA=30 mm was found in 561 cases, yielding a prevalence rate of 2.0%. Forty-eight patients underwent AAA repair. A percentage of 43.8% of these were classified as complex procedures. These consisted mostly of branched/fenestrated EVAR or EVAR with simultaneous exclusion of common iliac aneurysm.
Our study confirms contemporary prevalence rates of AAA. Almost half (43.8%) of screening-detected AAA required complex operations, a significant proportion. The complex aneurysms were, on average, larger than the non-complex cases and they were more likely to be cases that required surgery immediately after screening detection. Our data suggests that the nature of AAA is heterogenous, even in the screening-detected group requiring operation. This should spur interest in more studies to investigate this issue.
PubMed ID
27598471 View in PubMed
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8 records – page 1 of 1.