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[A centralised screening program for abdominal aortic aneurysms in Stockholm. Experiences from the first 18 months].

https://arctichealth.org/en/permalink/ahliterature108754
Source
Lakartidningen. 2013 Jun 5-18;110(23-24):1161-4
Publication Type
Article

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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Analysis of aortic wall stress and rupture risk in patients with abdominal aortic aneurysm with a gender perspective.

https://arctichealth.org/en/permalink/ahliterature136255
Source
J Vasc Surg. 2011 Aug;54(2):295-9
Publication Type
Article
Date
Aug-2011
Author
Emma Larsson
Fausto Labruto
T Christian Gasser
Jesper Swedenborg
Rebecka Hultgren
Author Affiliation
Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden. emma.larsson@ki.se
Source
J Vasc Surg. 2011 Aug;54(2):295-9
Date
Aug-2011
Language
English
Publication Type
Article
Keywords
Aged
Aged, 80 and over
Aorta, Abdominal - physiopathology - radiography
Aortic Aneurysm, Abdominal - complications - physiopathology - radiography
Aortic Rupture - etiology - physiopathology - radiography
Aortography - methods
Biomechanical Phenomena
Female
Finite Element Analysis
Humans
Image Interpretation, Computer-Assisted
Male
Middle Aged
Models, Cardiovascular
Retrospective Studies
Risk assessment
Risk factors
Sex Factors
Stress, mechanical
Sweden
Tomography, X-Ray Computed
Abstract
The most commonly used predictor of rupture of an abdominal aortic aneurysm (AAA) is the diameter; however, this does not estimate the true risk for each patient. Why women with AAAs have an increased growth rate, weaker aortic wall, and increased risk for rupture is yet unclear. It is likely that geometrical and biomechanical properties contribute to found gender differences. Several studies have shown that peak wall stress (PWS) and peak wall rupture risk (PWRR), predicted by a finite element (FE) analysis of AAAs derived from computed tomography (CT), is a better predictor of rupture than maximum diameter. The purpose of this study was to investigate if women with AAAs have an increased PWS and PWRR using an FE model compared to men.
Fifteen men and 15 women (AAAs 4-6 cm) were included. AAA geometry was derived from CT scans, and PWS and PWRR were estimated using the FE method. Comparisons were made by t test and Mann-Whitney test.
Mean age (women 73 years old vs men 71 years old) and mean AAA diameter was similar (49.7 mm vs 50.1 mm) for women and men. PWS did not differ for women 184 and men 198 kPa. PWRR was 0.54 (0.28-0.85) for women and 0.43 (0.24-0.66) for men, P = .06.
This is the first analysis of stress and strength of the aneurysm wall with a gender perspective. The reported higher rupture risk for women has previously not been tested with geometrical and biomechanical properties. PWS did not differ, but the PWRR was slightly higher in women. However, the difference did not reach statistical significance, probably due to the small sample size. In summary, the results in the present study suggest that differences in biomechanical properties could be a contributing explanation for the higher rupture risk reported for female patients with AAAs.
PubMed ID
21397436 View in PubMed
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The effect of ticagrelor on growth of small abdominal aortic aneurysms-a randomized controlled trial.

https://arctichealth.org/en/permalink/ahliterature309477
Source
Cardiovasc Res. 2020 02 01; 116(2):450-456
Publication Type
Journal Article
Multicenter Study
Randomized Controlled Trial
Research Support, Non-U.S. Gov't
Date
02-01-2020
Author
Anders Wanhainen
Kevin Mani
Joel Kullberg
Sverker Svensjö
Adam Bersztel
Lars Karlsson
Jan Holst
Anders Gottsäter
Anneli Linné
Peter Gillgren
Marcus Langenskiöld
Rebecka Hultgren
Joy Roy
Nils-Peter Gilgen
Håkan Ahlström
Frank A Lederle
Martin Björck
Author Affiliation
Department of Surgical Sciences, Vascular Surgery, Uppsala University, Uppsala SE-751 85, Sweden.
Source
Cardiovasc Res. 2020 02 01; 116(2):450-456
Date
02-01-2020
Language
English
Publication Type
Journal Article
Multicenter Study
Randomized Controlled Trial
Research Support, Non-U.S. Gov't
Keywords
Aged
Aged, 80 and over
Aortic Aneurysm, Abdominal - complications - diagnostic imaging - drug therapy
Disease Progression
Double-Blind Method
Female
Hemorrhage - chemically induced
Humans
Magnetic Resonance Angiography
Male
Middle Aged
Platelet Aggregation Inhibitors - adverse effects - therapeutic use
Sweden
Thrombosis - diagnostic imaging - etiology - prevention & control
Ticagrelor - adverse effects - therapeutic use
Time Factors
Treatment Outcome
Abstract
To evaluate if ticagrelor, an effective platelet inhibitor without known non-responders, could inhibit growth of small abdominal aortic aneurysms (AAAs).
In this multi-centre randomized controlled trial, double-blinded for ticagrelor and placebo, acetylic salicylic acid naïve patients with AAA and with a maximum aortic diameter 35-49?mm were included. The primary outcome was mean reduction in log-transformed AAA volume growth rate (%) measured with magnetic resonance imaging (MRI) at 12?months compared with baseline. Secondary outcomes include AAA-diameter growth rate and intraluminal thrombus (ILT) volume enlargement rate. A total of 144 patients from eight Swedish centres were randomized (72 in each group). MRI AAA volume increase was 9.1% for the ticagrelor group and 7.5% for the placebo group (P?=?0.205) based on intention-to-treat analysis, and 8.5% vs. 7.4% in a per-protocol analysis (P?=?0.372). MRI diameter change was 2.5?mm vs. 1.8?mm (P?=?0.113), US diameter change 2.3?mm vs. 2.2?mm (P?=?0.778), and ILT volume change 12.9% vs. 10.4% (P?=?0.590).
In this RCT, platelet inhibition with ticagrelor did not reduce growth of small AAAs. Whether the ILT has an important pathophysiological role for AAA growth cannot be determined based on this study due to the observed lack of thrombus modulating effect of ticagrelor.
The TicAAA trial is registered at the US National Institutes of Health (ClinicalTrials.gov) #NCT02070653.
PubMed ID
31135888 View in PubMed
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Female sex hormones and risk of incident abdominal aortic aneurysm in Norwegian women in the HUNT study.

https://arctichealth.org/en/permalink/ahliterature310368
Source
J Vasc Surg. 2019 11; 70(5):1436-1445.e2
Publication Type
Journal Article
Research Support, Non-U.S. Gov't
Date
11-2019
Author
Linn Åldstedt Nyrønning
Vibeke Videm
Pål R Romundstad
Rebecka Hultgren
Erney Mattsson
Author Affiliation
Department of Vascular Surgery, St. Olavs Hospital, Trondheim, Norway; Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway. Electronic address: linn.aldstedt.nyronning@ntnu.no.
Source
J Vasc Surg. 2019 11; 70(5):1436-1445.e2
Date
11-2019
Language
English
Publication Type
Journal Article
Research Support, Non-U.S. Gov't
Keywords
Aged
Aged, 80 and over
Aortic Aneurysm, Abdominal - blood - epidemiology - etiology
Coronary Disease - blood - complications - epidemiology
Estradiol - blood
Female
Follow-Up Studies
Hormone Replacement Therapy - adverse effects
Humans
Hypertension - blood - complications - epidemiology
Incidence
Longitudinal Studies
Middle Aged
Norway - epidemiology
Postmenopause - blood - drug effects
Proportional Hazards Models
Prospective Studies
Risk assessment
Risk factors
Smoking - adverse effects - blood - epidemiology
Time Factors
Abstract
The delayed development of abdominal aortic aneurysm (AAA) in women compared with men might be secondary to a protective effect from endogenous estrogens. The role of postmenopausal hormone therapy remains unclear. The aim of the present study was to evaluate the effect of female sex hormones compared with other risk factors associated with AAA through a long-term study of a large female cohort.
The present prospective cohort study included 20,024 postmenopausal women from the Norwegian Nord-Trøndelag Health Study. A total of 201 cases of AAA were identified during a median follow-up period of 18 years (295,554 person-years; 1995-2014). The data were recorded from questionnaires, physical measurements, medical records, blood sample test results, and the Norwegian Cause of Death Registry. The effect of risk factors was evaluated in a multiple Cox regression analysis. Multiple imputation was performed for missing data (n = 50 data sets). The serum estradiol concentrations in women with and without incidental AAAs were compared. The median interval from blood sample collection to the AAA diagnosis was 7 years.
Current smokers had >10-fold increased risk of incident AAA during the follow-up period (hazard ratio [HR], 10.9; 95% confidence interval [CI], 7.4-16.1). Positive associations were found for hypertension (HR, 2.0; 95% CI, 1.4-3.0) and coronary heart disease (HR, 2.2; 95% CI, 1.6-3.2). The HR associated with the current use of postmenopausal hormone therapy was 0.58 (95% CI, 0.6-1.5). No substantial difference in estradiol concentrations was found between women with and without AAA (P = .075).
The effect of female sex hormones on the risk of incident AAAs in women, as evaluated by the serum concentrations of estradiol and the use of postmenopausal hormone therapy, is clinically less important than the strong associations found with smoking, hypertension, and coronary heart disease.
PubMed ID
31248762 View in PubMed
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Genetic and environmental contributions to abdominal aortic aneurysm development in a twin population.

https://arctichealth.org/en/permalink/ahliterature98699
Source
J Vasc Surg. 2010 Jan;51(1):3-7; discussion 7
Publication Type
Article
Date
Jan-2010
Author
Carl Magnus Wahlgren
Emma Larsson
Patrik K E Magnusson
Rebecka Hultgren
Jesper Swedenborg
Author Affiliation
Department of Vascular Surgery, Karolinska University Hospital, Stockholm, Sweden. carl.wahlgren@karolinska.se
Source
J Vasc Surg. 2010 Jan;51(1):3-7; discussion 7
Date
Jan-2010
Language
English
Geographic Location
Sweden
Publication Type
Article
Keywords
Aged
Aged, 80 and over
Aortic Aneurysm, Abdominal - epidemiology - genetics
Environment
Female
Genetic Predisposition to Disease
Humans
Male
Middle Aged
Models, Genetic
Odds Ratio
Pedigree
Population Surveillance
Prevalence
Registries
Risk assessment
Risk factors
Sweden - epidemiology
Twins, Dizygotic - genetics
Twins, Monozygotic - genetics
Abstract
BACKGROUND: The contribution of hereditary and environmental factors to the development of abdominal aortic aneurysms (AAAs) is still partly unknown. The aim of this study was to analyze the role of these factors in a large population-based sample of twins. METHODS: The Swedish Twin Registry, containing data on twins born in the country since 1886, was cross-linked with the Inpatient Registry, providing national coverage of discharge diagnoses coded according to the International Classification of Diseases (ICD). All twins with an infrarenal AAA were identified. Concordance rates and tetrachoric correlations were calculated for monozygotic (MZ) and dizygotic (DZ) twins. Tetrachoric correlations were calculated assuming an underlying normal distribution of liability, with multiple factors contributing additively and a threshold value that discriminates between AAA and no AAA. Higher concordance rates and correlations of liability in MZ twins than in DZ twins suggest that genetic factors influence disease development. Structural equation modeling techniques, Mx-analyses, were used to estimate the contributions of genetic effects as well as shared and nonshared environmental factors for development of AAA. RESULTS: There were 172,890 twins registered at the time of the study including 265 twins (81% men; mean age 72 years; range, 48-94) with AAA. There were 7 MZ and 5 DZ concordant pairs as well as 44 MZ and 197 DZ discordant pairs with AAA. The probandwise concordance rates for MZ and DZ pairs were 24% and 4.8%, respectively. The tetrachoric correlations were 0.71 in MZ pairs and 0.31 in DZ pairs. The odds ratio (OR) was 71 (95% confidence interval [CI] 27-183) for MZ twins and 7.6 (95% CI 3.0-19) for DZ twins. In the structural equation models, genetic effects accounted for 70% (95% CI 0.33-0.83), shared environmental effects for 0% (95% CI 0-0.27), and nonshared environmental effects for 30% (95% CI 0.17-0.46) of the phenotypic variance among twins. CONCLUSION: These data provide robust epidemiologic evidence that heritability contributes to aneurysm formation. Concordances and correlations were higher in MZ compared with DZ twins, indicating genetic effects. There was a 24% probability that an MZ twin of a person with AAA will have the disease. The twin of an MZ twin with AAA had a risk of AAA that was 71 times that of the MZ twin of a person without AAA. A heritability of 70% of the total trait variance was estimated. The remaining variance was explained by nonshared environmental factors with no support for a role of shared environmental influences.
Notes
RefSource: J Vasc Surg. 2010 Jan;51(1):8
PubMed ID
19939604 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
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High proportion of known abdominal aortic aneurysm in patients with rupture indicates surveillance deficiency.

https://arctichealth.org/en/permalink/ahliterature282624
Source
J Vasc Surg. 2016 Oct;64(4):949-955.e1
Publication Type
Article
Date
Oct-2016
Author
Sayid Zommorodi
Joy Roy
Johnny Steuer
Rebecka Hultgren
Source
J Vasc Surg. 2016 Oct;64(4):949-955.e1
Date
Oct-2016
Language
English
Publication Type
Article
Keywords
Aged
Aged, 80 and over
Aortic Aneurysm, Abdominal - diagnostic imaging - epidemiology - mortality - therapy
Aortic Rupture - diagnostic imaging - epidemiology - mortality - prevention & control
Aortography - methods
Computed Tomography Angiography
Female
Humans
Incidence
Male
Patient compliance
Patient Preference
Predictive value of tests
Prognosis
Referral and Consultation
Refusal to Treat
Registries
Retrospective Studies
Risk factors
Sweden - epidemiology
Time Factors
Treatment Refusal
Watchful Waiting
Abstract
This study assessed the proportion of previously known abdominal aortic aneurysm (AAA) in patients presenting with a ruptured AAA (rAAA) and analyzed the reasons for nontreatment at the time of the initial AAA diagnosis.
This retrospective, observational study included all patients with rAAA admitted to a hospital in the counties of Stockholm and Gotland during 2009 to 2013. The patients' records were retrospectively reviewed, with extraction of data on previously detected AAA, demographics, and mortality at 30 and 90 days.
We identified 283 patients (76% men) with a mean age of 78.7 years. An AAA had been previously detected in 85 (30%). The overall mortality was higher (68% vs 53%; P = .018) and the intervention rate was lower in patients with a previously detected AAA (59% vs 82%, P 
PubMed ID
27666443 View in PubMed
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[Misleading study in The Lancet on the outcome of the Swedish AAA screening program].

https://arctichealth.org/en/permalink/ahliterature296834
Source
Lakartidningen. 2018 09 05; 115:
Publication Type
Journal Article
Comment
Date
09-05-2018
Author
Anders Wanhainen
Martin Björck
Sverker Svensjö
Anders Gottsäter
Jan Holst
Rebecka Hultgren
Anneli Linne
Joakim Nordanstig
Marcus Langenskiöld
Elisabet Skagius
Sven-Erik Persson
Carl-Magnus Wahlgren
Author Affiliation
Uppsala Universitet - Institutionen för Kirurgiska Vetenskaper Uppsala, Sweden Uppsala Universitet - Institutionen för Kirurgiska Vetenskaper Uppsala, Sweden.
Source
Lakartidningen. 2018 09 05; 115:
Date
09-05-2018
Language
Swedish
Publication Type
Journal Article
Comment
Keywords
Aortic Aneurysm, Abdominal
Cohort Studies
Humans
Male
Registries
Research Design
Sweden
Abstract
In a recent publication in The Lancet Johansson and colleagues claim no effect on aneurysm mortality among men participating in the Swedish AAA screening program, and question its justification. The study is, however, limited by a corrupt study design and incorrect data, making the publication misleading. On the contrary, several RCTs and contemporary nationwide data with sufficient follow-up clearly show that AAA screening saves lives and is highly cost-effective. The program has so far identified about 6000 men with an AAA, of whom 1500 have been operated on to prevent rupture. Thus, more than 750 men have experienced a longer life (by a mean of 8 years) as a result of the program. Continuous evaluation of the program is important but requires a scientifically sound methodology.
Notes
CommentOn: Lancet. 2018 Jun 16;391(10138):2441-2447 PMID 29916384
CommentIn: Lakartidningen. 2018 Sep 5;115: PMID 30204226
PubMed ID
30204225 View in PubMed
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Patients with abdominal aortic aneurysm have a high prevalence of popliteal artery aneurysms.

https://arctichealth.org/en/permalink/ahliterature284216
Source
Vasc Med. 2016 Aug;21(4):369-75
Publication Type
Article
Date
Aug-2016
Author
Viktoria Tuveson
Hedvig E Löfdahl
Rebecka Hultgren
Source
Vasc Med. 2016 Aug;21(4):369-75
Date
Aug-2016
Language
English
Publication Type
Article
Keywords
Aged
Aged, 80 and over
Aneurysm - diagnostic imaging - epidemiology
Aortic Aneurysm, Abdominal - diagnostic imaging - epidemiology
Aortography - methods
Computed Tomography Angiography
Female
Hospitals, University
Humans
Male
Mass Screening - methods
Middle Aged
Outpatient Clinics, Hospital
Popliteal Artery - diagnostic imaging
Predictive value of tests
Prevalence
Retrospective Studies
Sweden - epidemiology
Ultrasonography
Abstract
Patients with abdominal aortic aneurysms (AAA) are more prone to develop popliteal artery aneurysms (PAA), but the prevalence is not well known. Our aim was to investigate the prevalence of PAA in patients with AAA, and to determine whether a certain risk factor profile is more commonly found in patients with concurrent aneurysms. All AAA patients (ICD code I71.3, I71.4) attending the outpatient clinic at the Karolinska University Hospital between 2011 and 2013 were included in the study cohort (n=465); 48% (225) had been subjected to an ultrasound or computed tomography scan of their popliteal arteries. In these patients, three definitions of PAA were considered (? 10.5, ? 12, ? 15 mm), although the overall analysis is based on PAA ? 12 mm. The mean age was 70.7 years (SD 7.5), 89% were men, and the mean AAA diameter was 47 mm (SD 14). The prevalence of PAA was 19% (n=43) by definition ? 12 mm, and 11% (n=25) with 15 mm. Claudication was more frequently found in AAA patients with PAA than patients without PAA. Sensitivity between clinical examination and radiology was 26%, and the specificity for clinical examination was 90%. In conclusion, owing to the high prevalence of PAA in AAA patients, described by us and others, the low cost and risks associated with ultrasound and the poor sensitivity at clinical examination, all women and men with AAA should undergo one radiological examination of their popliteal arteries.
PubMed ID
27216869 View in PubMed
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15 records – page 1 of 2.