6 results on '"Nils-Peter Gilgen"'
Search Results
2. Long Term Outcome of Screen Detected Sub-Aneurysmal Aortas in 65 Year Old Men : a Single Scan After Five Years Identifies Those at Risk of Needing AAA Repair
- Author
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Nils Peter Gilgen, Knut Thorbjørnsen, Sverker Svensjö, and Anders Wanhainen
- Subjects
Male ,medicine.medical_specialty ,Kaplan-Meier Estimate ,Risk Assessment ,Ectasia ,Epidemiology ,Ultrasound ,Medicine ,Humans ,Mass Screening ,Cardiac and Cardiovascular Systems ,Single scan ,Aged ,Ultrasonography ,Subaneurysmal aorta ,Surgical repair ,Sweden ,Kardiologi ,Screen detected ,business.industry ,Incidence (epidemiology) ,Kirurgi ,Ectatic aorta ,medicine.disease ,Confidence interval ,Abdominal aortic aneurysm ,Surgery ,Prevention and control ,Disease Progression ,Screening ,Cardiology and Cardiovascular Medicine ,business ,Vascular Surgical Procedures ,Aortic Aneurysm, Abdominal ,Follow-Up Studies - Abstract
Objective: The epidemiology of sub-aneurysmal aortic dilatation (SAA) 25 - 29 mm is not fully understood, and the management of SAA is debated. Lack of evidence is particularly problematic in the screening setting. This study aimed to evaluate the long term outcome of men with screen detected SAAs, focusing on progression to an abdominal aortic aneurysm (AAA), and on the AAAs reaching the threshold diameter for surgical repair. Methods: Between 2006 and 2015, all 65 year old men with a screen detected SAA in middle Sweden were re-examined with ultrasound after five and 10 years. The primary outcomes were expansion to AAA >= 30 mm and progression to AAA >= 55 mm. Secondary outcomes were risk factors for progression, repair rate, and mortality. Results: A total of 1 020 65 year old men with a SAA were identified, of whom 940 (92.2%; 95% confidence interval 91.0 - 93.8) had follow up. The Kaplan-Meier estimated incidence of AAA >= 30 mm development after the five year follow up (which was de facto carried out after a mean of 4.9 years) was 65.8% (61.6 - 69.4), all < 55 mm. The corresponding KM-estimated incidence after the 10 year follow up (carried out after a mean of 11.9 years) was 95.1% (90.1 - 97.4), and 29.7% (18.0 - 39.7) reached >= 55 mm. All 41 SAAs eventually expanding to >= 55 mm were >= 30 mm at the five year follow up. Of these, 32 had surgical repair with 100% survival, six have scheduled repairs, and three (7.3%) were unfit for repair. The KM estimated all cause mortality rates at five and 10 years were 7.0% and 17.9%, respectively, with no proven AAA related deaths. Conclusion: A majority of SAAs eventually progress to an AAA, of which 30% are estimated to eventually reach the threshold for repair within 10 years. A follow up policy with an ultrasound examination after five years can safely and effectively identify those SAAs at risk of developing into clinically significant AAAs needing repair and may be considered for anyone with reasonably good life expectancy.
- Published
- 2021
3. Ultrasound Surveillance of Screening Detected Subaneurysmal Aortas in 65 Year Old Men: A Five Year Rescan Predicts Those at Risk of Developing Clinically Relevant Abdominal Aortic Aneurysms
- Author
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Knut Thorbjørnsen, Sverker Svensjö, Nils Peter Gilgen, and Anders Wanhainen
- Subjects
Surgery ,Cardiology and Cardiovascular Medicine - Published
- 2022
4. The effect of ticagrelor on growth of small abdominal aortic aneurysms-a randomized controlled trial
- Author
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Marcus Langenskiöld, Anneli Linné, Joel Kullberg, Håkan Ahlström, Martin Björck, Peter Gillgren, Kevin Mani, Jan Holst, Adam Bersztel, Frank A. Lederle, Anders Wanhainen, Joy Roy, Sverker Svensjö, Anders Gottsäter, Nils Peter Gilgen, Rebecka Hultgren, and Lars Karlsson
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0301 basic medicine ,Male ,medicine.medical_specialty ,Ticagrelor ,Time Factors ,Physiology ,Hemorrhage ,030204 cardiovascular system & hematology ,Placebo ,law.invention ,03 medical and health sciences ,0302 clinical medicine ,Randomized controlled trial ,Double-Blind Method ,law ,Physiology (medical) ,medicine.artery ,Internal medicine ,medicine ,Humans ,Thrombus ,Aged ,Aged, 80 and over ,Sweden ,Aorta ,medicine.diagnostic_test ,business.industry ,Magnetic resonance imaging ,Thrombosis ,Middle Aged ,medicine.disease ,Abdominal aortic aneurysm ,Pathophysiology ,030104 developmental biology ,Treatment Outcome ,Cardiology ,Disease Progression ,Female ,Cardiology and Cardiovascular Medicine ,business ,Magnetic Resonance Angiography ,Platelet Aggregation Inhibitors ,medicine.drug ,Aortic Aneurysm, Abdominal - Abstract
AIMS: To evaluate if ticagrelor, an effective platelet inhibitor without known non-responders, could inhibit growth of small abdominal aortic aneurysms (AAAs). METHODS AND RESULTS: In this multi-centre randomized controlled trial, double-blinded for ticagrelor and placebo, acetylic salicylic acid naive 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). CONCLUSION: 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. TRIAL REGISTRATION: The TicAAA trial is registered at the US National Institutes of Health (ClinicalTrials.gov) #NCT02070653. (Less)
- Published
- 2019
5. Outcome of the Swedish Nationwide Abdominal Aortic Aneurysm Screening Program
- Author
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Anders Wanhainen, Rebecka Hultgren, Anneli Linné, Jan Holst, Anders Gottsäter, Marcus Langenskiöld, Kristian Smidfelt, Martin Björck, Sverker Svensjö, Linda Lyttkens, Ewa Pihl, Tomas Wetterling, Per Kjellin, Ken Eliasson, Erik Wellander, Azin Narbani, Elisabet Skagius, Alexandra Hollsten, Martin Welander, Toste Länne, Bibbi Fröst, David Korman, Sven-Erik Persson, Birgitta Sigvant, Thomas Troëng, Markus Palm, Eva Ansgarius, Nils-Peter Gilgen, Christina Sjöström, Khatereh Djavani Gidlund, Peter Danielsson, Adam Bersztel, and Tomas Jonasson
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medicine.medical_specialty ,Aorta ,business.industry ,030204 cardiovascular system & hematology ,medicine.disease ,Abdominal aortic aneurysm ,Surgery ,Abdominal aortic aneurysm screening ,03 medical and health sciences ,0302 clinical medicine ,Aneurysm ,Physiology (medical) ,medicine.artery ,medicine ,030212 general & internal medicine ,Ultrasonography ,Cardiology and Cardiovascular Medicine ,business ,Mass screening ,Cause of death - Abstract
Background: A general abdominal aortic aneurysm (AAA) screening program, targeting 65-year-old men, has gradually been introduced in Sweden since 2006 and reached nationwide coverage in 2015. The aim of this study was to determine the outcome of this program. Methods: Data on the number of invited and examined men, screening-detected AAAs, AAAs operated on, and surgical outcome were retrieved from all 21 Swedish counties for the years 2006 through 2014. AAA-specific mortality data were retrieved from the Swedish Cause of Death Registry. A linear regression analysis was used to estimate the effect on AAA-specific mortality among all men ≥65 years of age for the observed time period. The long-term effects were projected by using a validated Markov model. Results: Of 302 957 men aged 65 years invited, 84% attended. The prevalence of screening-detected AAA was 1.5%. After a mean of 4.5 years, 29% of patients with AAA had been operated on, with a 30-day mortality rate of 0.9% (1.3% after open repair and 0.3% after endovascular repair, P P =0.020). The number needed to screen and the number needed to operate on to prevent 1 premature death were 667 and 1.5, respectively. With a total population of 9.5 million, the Swedish national AAA-screening program was predicted to annually prevent 90 premature deaths from AAA and to gain 577 quality-adjusted life-years. The incremental cost-efficiency ratio was estimated to be €7770 per quality-adjusted life-years. Conclusions: Screening 65-year-old men for AAA is an effective preventive health measure and is highly cost-effective in a contemporary setting. These findings confirm the results from earlier randomized controlled trials and model studies in a large population-based setting of the importance for future healthcare decision making.
- Published
- 2016
6. Nationwide Study of the Treatment of Mycotic Abdominal Aortic Aneurysms Comparing Open and Endovascular Repair
- Author
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Karl Sörelius, Anders Wanhainen, Mia Furebring, Martin Björck, Peter Gillgren, Kevin Mani, David Lindström, Rebecka Hultgren, Carl-Magnus Wahlgren, Håkan Roos, Marcus Langenskiöld, Timothy Resch, Roberta Vaccarino, Linda Bilos, Artai Pirouzram, Conny Arnerlöv, Gabor Simo, Mats Svensson, Johan Magnusson, Håkan Astrand, Nils-Peter Gilgen, Stefan Mellander, David Korman, Khatereh Djavani-Gidlund, Markus Palm, Mårten Huss, Adam Bertszel, Michael Docter, Christer Drott, Andreas Öjersjö, Olle Nelzén, Tomas Wetterling, and Ming Chu
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Male ,medicine.medical_specialty ,Staphylococcus aureus ,Kaplan-Meier Estimate ,030204 cardiovascular system & hematology ,03 medical and health sciences ,0302 clinical medicine ,Postoperative Complications ,Risk Factors ,Salmonella ,Physiology (medical) ,medicine.artery ,Odds Ratio ,Medicine ,Humans ,030212 general & internal medicine ,Registries ,Aged ,Demography ,Proportional Hazards Models ,Retrospective Studies ,Aorta ,business.industry ,Endovascular Procedures ,Streptococcus ,Bacterial Infections ,Middle Aged ,Surgery ,Open repair ,Female ,Cardiology and Cardiovascular Medicine ,business ,Aortic Aneurysm, Abdominal - Abstract
Background: No reliable comparative data exist between open repair (OR) and endovascular aneurysm repair (EVAR) for mycotic abdominal aortic aneurysms (MAAAs). This nationwide study assessed outcomes after OR and EVAR for MAAA in a population-based cohort. Methods: All patients treated for MAAAs in Sweden between 1994 and 2014 were identified in the Swedish vascular registry. The primary aim was to assess survival after MAAA with OR and EVAR. Secondary aims were analyses of the rate of recurrent infections and reoperations, and time trends in surgical treatment. Survival was analyzed using Kaplan-Meier and log-rank tests. A propensity score–weighted correction for risk factor differences in the 2 groups was performed, including the operation year to account for differences in treatment and outcomes over time. Results: We identified 132 patients (0.6% of all operated abdominal aortic aneurysms in Sweden). Mean age was 70 years (standard deviation, 9.2), and 50 presented with rupture. Survival at 3 months was 86% (95% confidence interval, 80%–92%), at 1 year 79% (72%–86%), and at 5 years 59% (50%–68%). The preferred operative technique shifted from OR to EVAR after 2001 (proportion EVAR 1994–2000 0%, 2001–2007 58%, 2008–2014 60%). Open repair was performed in 62 patients (47%): aortic resection and extra-anatomic bypass (n=7), in situ reconstruction (n=50), and patch plasty (n=3); 2 patients died intraoperatively. EVAR was performed in 70 patients (53%): standard EVAR (n=55), fenestrated/branched EVAR (n=8), and visceral deviation with stent grafting (n=7); no deaths occurred intraoperatively. Survival at 3 months was lower for OR than for EVAR (74% versus 96%, P P =0.054). A propensity score–weighted risk-adjusted analysis confirmed the early better survival associated with EVAR. During median follow-up of 36 and 41 months for OR and EVAR, respectively, there was no difference in long-term survival (5 years 60% versus 58%, P =0.771), infection-related complications (18% versus 24%, P =0.439), or reoperation (21% versus 24%, P =0.650). Conclusion: This study demonstrates a paradigm shift in treatment of MAAA in Sweden, with EVAR being the preferred treatment modality. EVAR was associated with improved short-term survival in comparison with OR, without higher associated incidence of serious infection-related complications or reoperations.
- Published
- 2016
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