Fredrik Lundgren

Decision-analytical model with lifetime estimation of costs and health outcomes for one-time screening for abdominal aortic aneurysm in 65-year-old men.

Abdominal aortic aneurysm (AAA) causes about 2 per cent of all deaths in men over the age of 65 years. A major improvement in operative mortality would have little impact on total mortality, so screening for AAA has been recommended as a solution. The cost‐effectiveness of a programme that invited 65‐year‐old men for ultrasonographic screening was compared with current clinical practice in a decision‐analytical model.

Cost-effectiveness of endarterectomy in patients with asymptomatic carotid artery stenosis†

Long‐term health outcomes and costs are important when deciding whether a strategy of carotid endarterectomy in addition to best medical management should be recommended for patients with asymptomatic carotid artery stenosis. This study investigated the cost‐effectiveness of such a strategy compared with a strategy of best medical management alone.

Screening for abdominal aortic aneurysm, a one-year follow up: An interview study

The purpose of the present study was to investigate whether screening for abdominal aortic aneurysm (AAA) and the finding of an enlarged aorta cause worries and affect the living situations of men with aneurysms or of their families within a 12-month follow-up period. Men invited to ultrasound screening and having an enlarged aorta (>or=30 mm) were invited for an interview. In total, 10 men were interviewed. The semi-structured interview was conducted by using an interview guide. Data was analyzed by using an interpretative phenomenological method. Three themes were identified: (i) feeling secure being under superintendence; (ii) living as usual, but repressing thoughts; and (iii) feeling disillusionment due to negative outcome. Being given the message that an enlarged aorta was discovered at the screening was manageable; hence, continuing growth of the aorta led to some unpleasant feelings. The men were living as usual; however, they all had some reflections about having an AAA and that something could happen when they least expected it. They reported thoughts about the consequences of the enlarged aorta itself and the surgery. In a one-year retrospective interview, men who have had an aneurysm detected in a screening program for AAA reported feeling secure being under superintendence. The one finding in our study concerning worries and effects on life situation could be interpreted as disillusionment due to negative outcomes. Decisions to introduce screening for AAA in Sweden and other countries with ongoing programs should be considered to include guidelines for how to handle disillusionment.

External Support of a Polytetrafluoroethylene Graft Improves Patency for Bypass to Below-Knee Arteries

BACKGROUND Patency and limb salvage after synthetic bypass to the arteries below the knee are inferior to that which can be achieved with autologous vein. The use of external support of synthetic polytetrafluoroethylene (PTFE) grafts to the below-knee position has been suggested to improve patency and limb salvage, a problem analyzed in this randomized clinical trial. We examined whether external graft support improves patency and/or limb salvage in patients undergoing reconstruction with synthetic PTFE grafts to the below-knee arteries. METHODS Three hundred thirty-four patients with critical limb ischemia undergoing PTFE bypass to below-knee arteries were randomly assigned to have an ordinary PTFE graft or one with external support. Follow-up was scheduled until amputation, death, or at most 5 years, whichever event occurred first. RESULTS Patients in both the femoropopliteal and femorodistal groups were randomized to have an externally supported PTFE graft (101/195 patients in the femoropopliteal group and 72/139 patients in the femorodistal group). Follow-up information was available for 329 of 334 randomized patients (99%). At 1 year postprocedure, primary patency for below-knee bypass was 0.55 (95% confidence interval [CI], 0.47-0.64) with and 0.42 (95% CI, 0.34-0.50) without externally supported PTFE grafts, and secondary patency was 0.58 (95% CI, 0.51-0.67) and 0.47 (95% CI, 0.39-0.56), respectively. The corresponding figures for limb salvage were 0.75 (95% CI, 0.68-0.82) and 0.69 (95% CI, 0.62-0.77), respectively. The log rank test revealed statistically significant differences between patients with or without externally supported grafts for patency (primary patency: χ2=4.2 [degrees of freedom=1; P=0.041]; secondary patency: χ2=4.3 [degrees of freedom=1; P=0.037]) but not for limb salvage (limb salvage: χ2=0.2 [degrees of freedom=1; P=0.657]). CONCLUSIONS External support to a PTFE graft used for bypass to below-knee arteries improves primary and secondary patency but not limb salvage.

Prognostic Factors for Failure of Primary Patency Within a Year of Bypass to the Foot in Patients with Diabetes and Critical Ischaemia

OBJECTIVE To find out whether we could identify prognostic factors for early failure of bypass to the foot in diabetic patients with critical ischaemia. DESIGN Retrospective series of consecutive patients. SETTING County hospital, Sweden. PATIENTS 43 diabetic patients who had 48 reconstructions for critical ischaemia between 1988 and 1994. INTERVENTIONS 48 elective vein bypass procedures to the feet. MAIN OUTCOME MEASURES Prognostic factors for primary patency. RESULTS Primary and secondary patency rates at one year were 72% (95% confidence interval (CI) 58 to 85) and 83% (95% CI 71 to 95), respectively. Limb salvage and survival rates at one year were 85% (95% CI 74 to 96) and 86% (95% CI 75 to 96), respectively. Vein graft of questionable quality, major wound healing problems, use of the reversed vein technique, and a narrow lumen (< 1.5 mm) of the recipient artery increased the hazard for failed primary patency by 17.3 (p = 0.003), 6.0 (p = 0.02), 4.7 (p = 0.03), and 3.9 (p = 0.05) times, respectively. Short vein bypass (p = 0.70), translocated or composite veins (p = 0.61), major postoperative oedema of the leg (p = 0.46), or questionable quality of the wall of the recipient artery (p = 0.29), however, had no significant independent effect on the primary patency rate. CONCLUSION Early primary patency after bypass to the foot in diabetic patients might improve if veins of questionable quality, major wound healing problems, thin reversed veins from the calf, and narrow recipient arteries can be avoided or handled more proficiently than in the present study.

Letter: In Response to Prof. MJ Goughs Second Comment on SCAMICOS

Aortic aneurysm routinely treated endovascularly in spite of deficient evidence. Weak basis that endovascular method is better than open surgery

Aortic aneurysm routinely treated endovascularly in spite of deficient evidence. Weak basis that endovascular method is better than open surgery

Aortic aneurysm routinely treated endovascularly in spite of deficient evidence. Weak basis that endovascular method is better than open surgery