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1.
Eur J Vasc Endovasc Surg ; 54(4): 415-422, 2017 Oct.
Article in English | MEDLINE | ID: mdl-28844552

ABSTRACT

OBJECTIVE/BACKGROUND: The objective was to observe for 1 year all patients in Norway operated on for symptomatic carotid stenosis with respect to (i) the time from the index event to surgery and neurological events during this time; (ii) the level in the healthcare system causing delay of surgical treatment; and (iii) the possible relationship between peri-operative use of platelet inhibitors and neurological events while awaiting surgery. METHODS: This was a prospective national multicentre study of a consecutive series of symptomatic patients. Patients were eligible for inclusion when referred for surgery. An index event was defined as the neurological event prompting contact with the healthcare system. All 15 departments in Norway performing carotid endarterectomy (CEA) participated. RESULTS: Three hundred and seventy one patients were eligible for inclusion between 1 April 2014 and 31 March 2015, and 368 patients (99.2%) were included. Fifty-four percent of the patients contacted their general practitioner on the day of the index event. Primary healthcare referred 84.2% of the patients to hospital on the same day as examined. In hospital median time from admission to referral for vascular surgery was 3 days. Median time between referral to the operating unit and actual CEA was 5 days. Overall, 61.7% of the patients were operated on within 2 weeks of the index event. Twelve patients (3.3%) suffered a new neurological event while awaiting surgery. The percentage of patients on dual antiplatelet therapy was lower (25.0%) in this group than among the other patients (62.6%) (p = .008). The combined 30 day mortality and stroke rate was 3.8%. CONCLUSION: This national study with almost complete inclusion and follow-up shows that the delays occur mainly at patient level and in hospital. The delay is associated with new neurological events. Dual antiplatelet therapy is associated with reduced risk of having a new neurological event before surgery.


Subject(s)
Carotid Stenosis , Endarterectomy, Carotid/methods , Ischemic Attack, Transient , Platelet Aggregation Inhibitors/therapeutic use , Stroke , Time-to-Treatment , Aged , Carotid Stenosis/complications , Carotid Stenosis/diagnosis , Carotid Stenosis/epidemiology , Carotid Stenosis/physiopathology , Endarterectomy, Carotid/statistics & numerical data , Humans , Ischemic Attack, Transient/epidemiology , Ischemic Attack, Transient/etiology , Ischemic Attack, Transient/prevention & control , Male , Middle Aged , Needs Assessment , Norway/epidemiology , Prospective Studies , Risk Assessment/methods , Severity of Illness Index , Stroke/epidemiology , Stroke/etiology , Stroke/prevention & control , Symptom Assessment/statistics & numerical data , Time-to-Treatment/standards , Time-to-Treatment/statistics & numerical data
2.
Scand J Immunol ; 79(5): 338-45, 2014 May.
Article in English | MEDLINE | ID: mdl-24612355

ABSTRACT

Chronic periodontitis (CP) and atherosclerotic and aortic aneurysmal vascular diseases (VD) are inflammatory conditions that share a number of predisposing factors. They have a complex genetic heritability and may share genetic risk factors, but a well-defined relationship is still not determined. In addition, distinct genetic patterns of predisposition have been associated with these diseases. Here, we investigated the association of polymorphisms in the IL-1 gene locus with CP in a case-case study analysing VD patients with or without CP. Seventy-four patients with VD of whom 36 had CP were genotyped for single nucleotide polymorphisms in the IL1A -889 (rs1800587), IL1B +3954 (rs1143634) and IL1B at -511 (rs16944) genes and for VNTR polymorphisms in the IL1RN gene. A significantly higher frequency (17%) for allele 1 (four repeats) of the IL1RN VNTR gene was found among the VD patients with CP compared to those without CP. In addition, the frequency of the IL1RN VNTR genotypes 1/1 (4/4 repeats) and 2/2 (2/2 repeats) were significantly higher and lower, respectively, in VD patients with CP. These findings suggest an association of genetic polymorphisms in the IL1-gene locus with risk for CP in patients with VD. The carriage of the risk genotypes, the development and the subsequent influence of CP on systemic health may constitute an additional burden in the pathogenesis of VD. This emphasizes the importance of effective periodontal treatment in patients with VD.


Subject(s)
Aortic Aneurysm/epidemiology , Atherosclerosis/epidemiology , Chronic Periodontitis/epidemiology , Genetic Predisposition to Disease , Interleukin 1 Receptor Antagonist Protein/genetics , Interleukin-1/genetics , Aged , Aged, 80 and over , Aortic Aneurysm/genetics , Atherosclerosis/genetics , Chronic Periodontitis/genetics , DNA Mutational Analysis , Female , Gene Frequency , Genetic Association Studies , Genotype , Humans , Male , Middle Aged , Polymorphism, Single Nucleotide , Scandinavian and Nordic Countries
3.
Br J Surg ; 98(11): 1546-55, 2011 Nov.
Article in English | MEDLINE | ID: mdl-21725968

ABSTRACT

BACKGROUND: The aim of this study was to determine the cost-effectiveness of ultrasound screening for abdominal aortic aneurysm (AAA) in men aged 65 years, for both the Netherlands and Norway. METHODS: A Markov model was developed to simulate life expectancy, quality-adjusted life-years, net health benefits, lifetime costs and incremental cost-effectiveness ratios for both screening and no screening for AAA. The best available evidence was retrieved from the literature and combined with primary data from the two countries separately, and analysed from a national perspective. A threshold willingness-to-pay (WTP) of €20,000 and €62,500 was used for data from the Netherlands and Norway respectively. RESULTS: The additional costs of the screening strategy compared with no screening were €421 (95 per cent confidence interval 33 to 806) per person in the Netherlands, and the additional life-years were 0·097 (-0·180 to 0·365), representing €4340 per life-year. For Norway, the values were €562 (59 to 1078), 0·057 (-0·135 to 0·253) life-years and €9860 per life-year respectively. In Norway the results were sensitive to a decrease in the prevalence of AAA in 65-year-old men to 1 per cent, or lower. Probabilistic sensitivity analyses indicated that AAA screening has a 70 per cent probability of being cost-effective in the Netherlands with a WTP threshold of €20,000, and 70 per cent in Norway with a threshold of €62,500. CONCLUSION: Using this model, screening for AAA in 65-year-old men would be highly cost-effective in both the Netherlands and Norway.


Subject(s)
Aortic Aneurysm, Abdominal/prevention & control , Aortic Rupture/prevention & control , Mass Screening/economics , Aged , Aortic Aneurysm, Abdominal/economics , Aortic Rupture/economics , Cost-Benefit Analysis , Health Care Costs , Humans , Male , Markov Chains , Netherlands , Norway , Quality-Adjusted Life Years
4.
Angiology ; 62(4): 301-5, 2011 May.
Article in English | MEDLINE | ID: mdl-21474466

ABSTRACT

Elevated plasma levels of vascular inflammatory markers have been reported in patients with peripheral arterial disease (PAD). We assessed the effect of supervised exercise training (ET) on vascular inflammation, hypothesizing that ET reduces plasma levels of the endothelial adhesion molecules E-selectin, intercellular adhesion molecule-1 (ICAM-1), and vascular cell adhesion molecule-I (VCAM-I). Twenty-nine patients with PAD underwent a supervised ET program for 8 weeks. Before and after ET, walking distances (pain-free, PWD; maximal, MWD) were determined by a standard treadmill test. Plasma levels of E-selectin and ICAM-I were significantly reduced (E-selectin: 45.5-40.4 ng/mL, P = .013); ICAM-I: 342.0-298.0 ng/mL, P = .016). VCAM-1 levels were unchanged. Walking distances increased significantly (PWD: median 77-150 m, P < .001; MWD: median 306-535 m, P < .001). In conclusion, 8 weeks of ET in patients with PAD reduces plasma levels of the specific endothelium-derived inflammatory markers E-selectin and ICAM-I.


Subject(s)
E-Selectin/blood , Exercise Therapy , Intercellular Adhesion Molecule-1/blood , Peripheral Vascular Diseases/blood , Peripheral Vascular Diseases/therapy , Aged , Exercise Test , Female , Humans , Male , Middle Aged , Peripheral Vascular Diseases/physiopathology , Statistics, Nonparametric , Walking/physiology
5.
Eur J Vasc Endovasc Surg ; 40(2): 234-40, 2010 Aug.
Article in English | MEDLINE | ID: mdl-20570187

ABSTRACT

OBJECTIVES: The aim of this study was to determine the mid-term patency and the clinical outcome after stenting of chronic occluded caval and iliofemoral venous segments. DESIGN: Observational study. MATERIAL/METHODS: During the period 2000 and 2009, 2400 patients with chronic venous insufficiency (CVI) were evaluated, and 34 with chronic venous occlusions after deep venous thrombosis (DVT) were selected for endovascular treatment. The median age was 41 (range 15-63) years, and 19 were female. The following investigations were undertaken: colour duplex ultrasound (CDU), ascending venography (AV), venous occlusion plethysmography (VOP), venous pressure gradient (VPG) and CT venography or trans-femoral/popliteal venography. The major symptoms were venous claudication, oedema, pain and ulcer. All patients were treated by stenting occluded segments. Self-expanding stents were deployed in 22 iliofemoral, nine iliac and one caval-iliac-femoral. Twenty-one procedures required stenting across the inguinal ligament. RESULTS: Primary recanalisation was accomplished in 32/34 (94%). The median follow-up was 33 months (1-96) with clinical examination, CDU and VOP. Two-year primary patency was 14/21 (67%), primary-assisted patency 16/21(76%), and secondary patency was 19/21 (90%). Venous claudication and oedema resolved in those successfully recanalised. Four of the seven ulcers healed. CONCLUSION: Stenting to treat venous claudication, oedema and recurrent venous ulcer caused by post-thrombotic chronic venous occlusions has positive clinical outcome and good mid-term patency.


Subject(s)
Stents , Venous Insufficiency/therapy , Venous Thrombosis/complications , Adolescent , Adult , Chronic Disease , Female , Humans , Male , Middle Aged , Plethysmography , Treatment Outcome , Ultrasonography, Doppler, Color , Ultrasonography, Doppler, Duplex , Vascular Patency , Venous Insufficiency/etiology , Young Adult
6.
Injury ; 41(6): 599-605, 2010 Jun.
Article in English | MEDLINE | ID: mdl-19945102

ABSTRACT

OBJECTIVE: This study aims to evaluate the costs and health outcome for surgical and conservative treatment of displaced proximal humeral fractures. DESIGN: This study is a randomised controlled trial. PARTICIPANTS: This study included 50 patients aged 60 or older admitted to hospital with a severely displaced three- or four-part fracture. INTERVENTIONS: The patients were treated surgically with an angular stable interlocking implant (25 patients) or conservative treatment (25 patients). MAIN OUTCOME MEASURE: The outcomes measured included quality-adjusted life years (QALYs) and societal costs. RESULTS: At 12 months' follow-up, the mean difference in the number of QALYs was 0.027 (95% confidence interval (CI)=-0.025, 0.078) while the mean difference in total health-care costs was 597 euro in favour of surgery (95% CI=-5291, 3777). CONCLUSION: There was no significant difference in QALYs or costs between surgical and conservative treatment of severe displaced proximal humeral fractures.


Subject(s)
Fracture Fixation/methods , Health Care Costs , Models, Statistical , Outcome Assessment, Health Care , Shoulder Fractures/therapy , Aged , Aged, 80 and over , Cost of Illness , Female , Fracture Fixation/economics , Humans , Length of Stay , Male , Middle Aged , Quality-Adjusted Life Years , Shoulder Fractures/economics , Shoulder Fractures/surgery , Time Factors
7.
Eur J Vasc Endovasc Surg ; 36(4): 466-72, 2008 Oct.
Article in English | MEDLINE | ID: mdl-18675560

ABSTRACT

OBJECTIVES: To evaluate the durability of venous valve reconstruction (VVR) and its benefits in terms of symptom improvement, ulcer healing and symptom/ulcer recurrence among patients with secondary chronic venous insufficiency (SCVI) in whom superficial venous surgery and compression treatment had failed. METHODS: During a ten year period (1993-2004) 1800 patients with chronic venous insufficiency (CVI) were evaluated by colour duplex ultrasound (CDU) and ambulatory venous pressure measurement (AVP). Approximately two thirds of patients had SCVI. Initial treatment consisted of compression therapy for a 6 month period. In addition, superficial vein and perforator surgery was performed in those presenting with reflux in these venous systems. 121 patients who did not improve with this treatment were investigated by ascending venography, descending video venography, air plethysmography and measurement of post-ischaemic venous pressure gradient. Thirty two cases having venous reflux without obstruction were selected for VVR. RESULTS: The ulcer healing rate within three months was 68% (13/19 patients). VVR resulted in valvular competence and a clinical success rate of 47% and 40% after 3 and 7 years respectively. In 8/13 (54%) of patients with a healed leg ulcer, a median post-operative AVP reduction of 33 mm Hg (range 20-38) was recorded. The durability of clinical success was numerically longer in patients with haemodynamic improvement (n=10) median 24 months (12-108), when compared with that in those without haemodynamic improvement (n=22) median 18 months (6-108). Popliteal vein reconstruction was part of the VVR procedure in all patients with haemodynamic improvement (post-op. AVP reduction >or=20 mm Hg). VVR at the popliteal level alone or combined with inguinal reconstruction seemed to be the one significant factor associated with haemodynamic improvement (P=0.014, Chi squared). CONCLUSION: VVR may lead to ulcer healing, but when performed at the popliteal level, haemodynamic improvement can be obtained along with a longer recurrence-free period (durability). VVR should be considered in the treatment of patients with SCVI who do not respond to superficial venous surgery and compression treatment.


Subject(s)
Leg/blood supply , Veins/surgery , Venous Insufficiency/surgery , Adult , Aged , Angioscopy , Anticoagulants/therapeutic use , Chronic Disease , Female , Humans , Male , Middle Aged , Ultrasonography, Doppler, Duplex , Varicose Ulcer/pathology , Veins/diagnostic imaging , Veins/transplantation , Venous Insufficiency/diagnostic imaging , Venous Insufficiency/physiopathology , Venous Pressure , Wound Healing
8.
Scand J Surg ; 97(1): 56-62, 2008.
Article in English | MEDLINE | ID: mdl-18450207

ABSTRACT

BACKGROUND AND AIMS: Treatment with autologous, bone marrow mononuclear stem cells has shown effects in patients with chronic limb ischaemia in one randomized clinical study. The aim of the study was to test the potential effect of stem cell treatment in a strict defined group of patients with stable critical limb ischaemia (CLI). DESIGN: A prospective, combined-centre pilot study. MATERIAL: Eight patients with CLI of the lower extremities, and without any other treatment options. METHODS: Bone marrow cells were harvested from the patient's iliac crest and, after separation, injected into the calf muscles of the affected leg. Outcome was evaluated by digital subtraction angiography (DSA), visual analogue scale (VAS) and several non-invasive circulatory physiological tests. RESULTS: There were no complications from the procedures. Two patients were amputated two months after cell injection. Five patients reported pain relief after four months. Five patients could be evaluated at eight months. According to VAS and physiological tests, they were all either stable or showed improvement. CONCLUSION: This method seems to be a safe option for treating patients with CLI. Inclusion of patients took a long time, mainly because many patients with CLI are offered endovascular treatment in our institution. While symptomatic improvement was found in individual patients, larger trials are required to investigate efficacy. This will probably require multi-centre participation.


Subject(s)
Bone Marrow Transplantation , Ischemia/therapy , Leg/blood supply , Adult , Aged , Aged, 80 and over , Angiography , Female , Humans , Male , Middle Aged , Pain Measurement , Pilot Projects , Prospective Studies , Transplantation, Autologous , Treatment Outcome
9.
Eur J Vasc Endovasc Surg ; 33(1): 3-12, 2007 Jan.
Article in English | MEDLINE | ID: mdl-17055756

ABSTRACT

OBJECTIVES: To compare the effect of optimal medical treatment only (OMT) with OMT combined with percutaneous transluminal angioplasty (OMT+PTA) in patients with intermittent claudication (IC). DESIGN: A single centre prospective, randomised study. Quality of life (QoL) was the primary outcome measure. Secondary measures were ankle-brachial-index (ABI), treadmill walking distances and mortality. METHODS: From a total of 434 patients considered for inclusion into the trial, only 56 patients with disabling IC fulfilled the inclusion criteria. The patients were randomised into treatment groups consisting of 28 patients each and followed for 2 years. ABI and treadmill walking distances were measured in addition to the visual analogue scale (VAS) for pain evaluation, and QoL assessment using the Short Form (SF-36 and Claudication Scale (CLAU-S). RESULTS: The demographic data in the 2 groups were almost identical. After 2 years of follow-up the ABI, the treadmill walking distances and the VAS were significant improved in the group treated with OMT+PTA, compared to the group treated with OMT only (p<0.01 for all). Furthermore, some variables from the QoL assessment also showed a significant improvement in favour of the OMT+PTA group (p<0.05 for all). CONCLUSION: The advantage of conducting a single centre study and adhering to very strict inclusion criteria was illustrated by the homogenous demographic data of the two groups. This partly outweighed the disadvantage of having included a relatively small number of patients. Early intervention with PTA in addition to OMT seems to have a generally more positive effect compared to OMT only, on haemodynamic, functional as well as QoL aspects during the first 2 years in patients with IC.


Subject(s)
Angioplasty, Balloon , Intermittent Claudication/therapy , Leg/blood supply , Peripheral Vascular Diseases/therapy , Quality of Life , Aged , Ankle/blood supply , Blood Pressure , Brachial Artery/physiopathology , Female , Follow-Up Studies , Humans , Intermittent Claudication/etiology , Intermittent Claudication/mortality , Intermittent Claudication/physiopathology , Male , Middle Aged , Pain/etiology , Pain Management , Pain Measurement , Patient Compliance , Patient Selection , Peripheral Vascular Diseases/complications , Peripheral Vascular Diseases/mortality , Peripheral Vascular Diseases/physiopathology , Prospective Studies , Surveys and Questionnaires , Time Factors , Treatment Outcome , Walking
10.
Eur J Vasc Endovasc Surg ; 33(1): 20-5, 2007 Jan.
Article in English | MEDLINE | ID: mdl-16934498

ABSTRACT

OBJECTIVES: The purpose of this study was to compare the circulatory responses to walking in patients with peripheral atherosclerotic disease (PAD) and healthy controls. METHODS: The participants were eleven patients with diagnosed PAD, and a control group of six healthy age-matched adults. Blood pressure, heart rate (HR), and acral skin perfusion were recorded continuously before, during and after a walking exercise on a treadmill. RESULTS: The patients walked to maximum claudication distance (MCD) on a treadmill, median walking distance 103 (34-223) metres [median (range)], at 3.3 (1.0-4.5) km/h. There was a steep increase in HR and mean arterial pressure (MAP) while the patients were walking. At claudication the median rise in MAP was 46.6 (10.3-61.3) mmHg, systolic blood pressure (SP) increased by 84.9 (31.4-124.9) mmHg, and diastolic blood pressure (DP) by 21.7 (-2.1-31.7) mmHg. HR increased by 34.9 (12.9-48.1) beats/min. The control group walked for 5 minutes at 3.2 (3.0-3.3) km/h. In the control group the blood pressure initially increased moderately but stabilised thereafter. Median rise in MAP during walking was 8.5 (5.6-14.6) mmHg, SP increased by 30.9 (6.6-41.5) mmHg, and DP was reduced by -1.4 (-5.4-1.5) mmHg. HR increased by 27.1 (18.8-34.9) beats/min. We found no significant differences in acral skin perfusion during walking exercise between the patients and control group. CONCLUSIONS: In patients with PAD, blood pressure increased continuously and significantly when walking to MCD (dynamic exercise). The level of increase in blood pressure was similar to that caused in response to isometric exercise.


Subject(s)
Atherosclerosis/physiopathology , Blood Pressure , Intermittent Claudication/physiopathology , Leg/blood supply , Peripheral Vascular Diseases/physiopathology , Walking , Aged , Aged, 80 and over , Atherosclerosis/complications , Case-Control Studies , Female , Heart Rate , Humans , Intermittent Claudication/etiology , Male , Middle Aged , Peripheral Vascular Diseases/complications , Regional Blood Flow , Skin/blood supply , Time Factors
11.
Eur J Vasc Endovasc Surg ; 32(5): 570-6, 2006 Nov.
Article in English | MEDLINE | ID: mdl-16919978

ABSTRACT

OBJECTIVES: To evaluate the patency of EVVP and its effect in symptom relief, ulcer healing and ulcer-free period in patients with PCVI. METHODS: Between 1993 and 2004, 1800 patients with CVI were evaluated and seventeen with PCVI were selected for EVVP. They were all investigated with ambulatory venous pressure measurement (AVP), colour duplex ultrasound (CDU), ascending venography and descending video venography. The CEAP classification was used to group the patients. Six patients were C4, four C5 and seven C6. All had deep reflux and high levels of AVP. RESULTS: All procedures were technically successful. The ulcer healing rate was 4/7 (57%) within 3 months. All C4 patients experienced symptom improvement postoperatively and had a median recurrence free period of 72 (range 60-122) months. The C5 group had an median ulcer free period of 61 months (12-72) and the C6 of median 48 (12-72) months. Single valve plasties (4) reached a median competence period of 48 months (12-72), 12 multiple valve plasties at the same level show a median 78 months (63-122) and 10 multilevel repairs median 54 months (12-96). Multiple valve plasties at the same level (multi-station plasties) performed on the C4 group seemed to yield the longest durability with a median of 103 months (84-122). CONCLUSION: EVVP with an ulcer healing rate of 57% and satisfactory symptom improvement seems to be an alternative of surgical treatment for selected patients with PCVI. The durability of this technique seems to be related to clinical severity and the multiplicity of repairs.


Subject(s)
Varicose Ulcer/surgery , Vascular Surgical Procedures , Venous Insufficiency/surgery , Adult , Aged , Chronic Disease , Evaluation Studies as Topic , Female , Follow-Up Studies , Humans , Male , Middle Aged , Patient Selection , Phlebography , Severity of Illness Index , Treatment Outcome , Ultrasonography, Doppler, Color , Varicose Ulcer/etiology , Varicose Ulcer/physiopathology , Vascular Patency , Venous Insufficiency/complications , Venous Insufficiency/physiopathology , Venous Pressure
12.
Eur J Vasc Endovasc Surg ; 31(1): 53-8, 2006 Jan.
Article in English | MEDLINE | ID: mdl-16269254

ABSTRACT

OBJECTIVES: To evaluate the sensitivity, specificity, positive and negative predictive value of contrast-enhanced (gadolinium) magnetic resonance imaging (CE-MRA) and colour duplex ultrasound (CDU) of lower limb arteries. DESIGN: Prospective, single centre study. MATERIAL AND METHODS: A consecutive series of 58 patients with intermittent claudication (IC) were examined with CE-MRA and CDU from the infrarenal aorta to the tibio-peroneal trunk with digital subtraction angiography (DSA) as reference. The arterial tree was divided into 15 segments, pooled into three regions; suprainguinal, thigh and knee. Sensitivity, specificity, positive and negative predictive values for significant obstructions were calculated. Cohen Kappa statistics was used to establish agreement between the three methods. RESULTS: The sensitivity (specificity in parentheses) for significant obstructions in the suprainguinal region were 96% (94%) for CE-MRA and 91% (96%) for CDU, in the thigh region 92% (95%) for CE-MRA and 76% (99%) for CDU, and in the knee region 93% (96%) for CE-MRA and 33% (98%) for CDU. CDU failed to visualize 10% of suprainguinal, 2% of thigh and 13% of knee-region arterial segments. CONCLUSIONS: Both CE-MRA and CDU are good alternatives to DSA in the suprainguinal- and thigh-region. In the knee region only CE-MRA can be relied upon as an alternative to DSA. Imaging by CDU is not suited to situations were evaluation of runoff vessels is important.


Subject(s)
Angiography, Digital Subtraction/methods , Aorta, Abdominal , Gadolinium DTPA , Intermittent Claudication/diagnosis , Magnetic Resonance Angiography/methods , Tibial Arteries , Ultrasonography, Doppler, Color/methods , Aged , Aged, 80 and over , Aorta, Abdominal/diagnostic imaging , Aorta, Abdominal/pathology , Contrast Media/administration & dosage , Female , Follow-Up Studies , Gadolinium DTPA/administration & dosage , Humans , Infusions, Intravenous , Male , Middle Aged , Predictive Value of Tests , Prospective Studies , Tibial Arteries/diagnostic imaging , Tibial Arteries/pathology
13.
Eur J Vasc Endovasc Surg ; 28(6): 645-50, 2004 Dec.
Article in English | MEDLINE | ID: mdl-15531202

ABSTRACT

OBJECTIVES: Reporting the long-term results of subintimal angioplasty (SA) in patients with intermittent claudication (IC). DESIGN: A prospective study. PATIENTS: One hundred and sixteen SA procedures were performed in 104 patients, from February 1997 to January 2000. METHODS: This is a prospective study of patients treated for IC with infrainguinal SA. Primary assisted patency rates were calculated, also on intention to treat basis. Univariate and multivariate Cox regression tests were used to assess whether patency was correlated with co-morbidities, run-off or occlusion length. RESULTS: There was no early mortality. Technical success was achieved in 101 cases (87%). Primary assisted patency rates on intention to treat basis (116 cases) at 6, 12, 36 and 60 months were 69, 62, 57 and 54%, respectively. For successfully recanalized patients (101 cases) these respective numbers are 79, 70, 66 and 64%. Length of occlusion, age and male gender were independent risk factors for reocclusion. CONCLUSIONS: The satisfactory results obtained in the present study are probably due to two main factors. First, the three participating radiologist are highly skilled and experienced. Secondly, a conscientious surveillance was adhered to, so that restenoses could be diagnosed and treated early. SA is a relevant alternative to bypass surgery in patients with disabling IC due to long femoro-popliteal occlusions. It is far less traumatic than conventional vascular reconstructions, complications are few and not serious. Very importantly, SA never interfered with later successful vascular surgery. Therefore, we have adopted SA as the primary treatment for patients with IC when medical treatment alone has not been satisfactory.


Subject(s)
Angioplasty/methods , Intermittent Claudication/surgery , Adult , Aged , Aged, 80 and over , Collateral Circulation , Female , Femoral Artery/diagnostic imaging , Femoral Artery/surgery , Humans , Intermittent Claudication/diagnostic imaging , Intermittent Claudication/epidemiology , Male , Middle Aged , Popliteal Artery/diagnostic imaging , Popliteal Artery/surgery , Prospective Studies , Radiography, Interventional , Risk Factors , Treatment Outcome , Vascular Patency
14.
Ugeskr Laeger ; 162(12): 1742-4, 2000 Mar 20.
Article in Danish | MEDLINE | ID: mdl-10766656

ABSTRACT

Medical termination of early pregnancy with mifepristone (RU 486) followed by a prostaglandin analogue (Cervagem) is a fairly new abortion method in surgical and gynaecological departments in Denmark. Sixty-two patients were evaluated during the period December 1, 1997 to the June 10, 1998 at Kalundborg hospital. The success rate was 97%. Side effects were rare. The study illustrates the need for strong analgesics in half of the patients. In conclusion RU 486 followed by a prostaglandin analogue provides an efficient and attractive alternative to surgical abortion methods.


Subject(s)
Abortifacient Agents, Nonsteroidal/administration & dosage , Abortifacient Agents, Steroidal/administration & dosage , Abortion, Induced/methods , Alprostadil/analogs & derivatives , Mifepristone/administration & dosage , Prostaglandins E, Synthetic/administration & dosage , Abortifacient Agents, Nonsteroidal/adverse effects , Abortifacient Agents, Steroidal/adverse effects , Administration, Intravaginal , Adolescent , Adult , Alprostadil/administration & dosage , Alprostadil/adverse effects , Denmark , Female , Humans , Mifepristone/adverse effects , Pregnancy , Prostaglandins E, Synthetic/adverse effects , Retrospective Studies
16.
Tidsskr Nor Laegeforen ; 116(25): 2996-9, 1996 Oct 20.
Article in Norwegian | MEDLINE | ID: mdl-8975422

ABSTRACT

Local intra-arterial low-dose thrombolysis has become a therapeutic alternative for acute and subacute occlusion of vascular grafts and native vessels in the lower limbs. The series comprises 31 patients treated with Streptokinase as thrombolytic agent. Complete primary thrombolysis was achieved in 20 patients, whereas in 11 patients the outcome was only partially successful or a failure. Vascular stenoses were considered to precipitate thrombosis in 18 cases, and prompted percutaneous transluminal angioplasty after thrombolysis. Two-year patency was 48% (30-66%) in the total series and 74% (56-92%) among the patients with successful primary thrombolysis. There were no major complications. Five patients sustained local inguinal haemorrhage, of whom three required surgical revision. Local intra-arterial thrombolysis is an elaborate procedure associated with potential hazardous complications. It should be carried out in institutions with radiological and vascular surgical expertise.


Subject(s)
Arterial Occlusive Diseases/drug therapy , Fibrinolytic Agents/administration & dosage , Plasminogen Activators/administration & dosage , Streptokinase/administration & dosage , Thromboembolism/drug therapy , Thrombolytic Therapy , Adult , Aged , Contraindications , Female , Humans , Leg/blood supply , Male , Middle Aged , Thrombolytic Therapy/methods
17.
18.
Tidsskr Nor Laegeforen ; 112(13): 1697-9, 1992 May 20.
Article in Norwegian | MEDLINE | ID: mdl-1509426

ABSTRACT

15 patients who had elective aortic reconstruction for infra-renal aortic aneurysm (nine patients) or aortoiliac occlusive disease (six patients) were evaluated using postoperative computerized tomography. The assessment was performed 1-2 weeks, 6-8 weeks and 6-8 months after implantation of woven Dacron graft. All patients were without clinical or laboratory signs of infection. The presence or absence of retroperitoneal air or fluid collections was assessed. In patients operated on for aneurysms, perigraft fluid was present in two cases 6-8 weeks after operation, but had disappeared within 6-8 months. Even after only 1-2 weeks, no accumulation of periprosthetic fluid was found in patients operated on for occlusive disease. Retroperitoneal air was not seen in any of the cases. It is concluded that perigraft fluid may be a "normal" phenomenon during the early postoperative period in patients operated on for abdominal aortic aneurysm.


Subject(s)
Aorta, Abdominal/surgery , Aortic Aneurysm/surgery , Blood Vessel Prosthesis , Exudates and Transudates , Postoperative Complications/diagnostic imaging , Aged , Aorta, Abdominal/diagnostic imaging , Arteriosclerosis/surgery , Blood Vessel Prosthesis/adverse effects , Female , Humans , Male , Middle Aged , Tomography, X-Ray Computed
19.
Tidsskr Nor Laegeforen ; 111(11): 1353-5, 1991 Apr 30.
Article in Norwegian | MEDLINE | ID: mdl-2042152

ABSTRACT

All 327 patients treated in Oslo City Hospital for blunt chest injuries during a period of three months were registered prospectively. 274 were treated outside hospital. Traffic accidents accounted for 10% of the total number of patients, but 40% of the hospitalized patients. Accidents in the home were most numerous, with many complications and admissions to hospital. 20% of the hospitalizations, were for injuries due to violence. The registration indicates more than 1,300 patients with chest injuries per year, of whom more than 40 are severely multitraumatized. The chest injury was serious in 21 patients, moderate in 306. 13.5% of the cases were complicated by pneumo-hemothorax and lung contusion, or by late complications such as pneumonia and atelectases. Seven patients (2.1%) died. These were old, physically disabled or multitraumatized. 100 patients had extrathoracic injuries, of whom 15 had intrathoracic injuries as well. In 227 patients with thoracic injuries only, the injuries were intrathoracic in six of them. The mortality in patients with chest wall injuries only was 0.7%, as compared with 20% in patients with intrathoracic injuries.


Subject(s)
Thoracic Injuries/mortality , Wounds, Nonpenetrating/mortality , Accidents/mortality , Accidents/statistics & numerical data , Adolescent , Adult , Aged , Child , Female , Humans , Male , Middle Aged , Norway/epidemiology , Prospective Studies , Thoracic Injuries/diagnosis , Thoracic Injuries/etiology , Trauma Severity Indices , Wounds, Nonpenetrating/diagnosis , Wounds, Nonpenetrating/etiology
20.
Tidsskr Nor Laegeforen ; 110(11): 1331-4, 1990 Apr 30.
Article in Norwegian | MEDLINE | ID: mdl-2339376

ABSTRACT

The syndrome of intestinal angina is rare and can be effectively treated by revascularization of the obstructed arteries. Usually the time from onset of symptoms to diagnosis is several months. Because of abdominal pain and loss of weight, abdominal malignancy is often suspected. At present there is no specific diagnostic test, and angiography with two projections is necessary. During the last decade 373 patients with intestinal angina have been reported. Our group presents two patients who have been operated on. After a follow-up of 18 and 19 months respectively, they are still without symptoms.


Subject(s)
Intestines/blood supply , Ischemia/surgery , Vascular Surgical Procedures/methods , Adult , Aged , Angiography , Celiac Artery/surgery , Chronic Disease , Female , Follow-Up Studies , Humans , Male , Mesenteric Arteries/surgery , Middle Aged
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