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  • 1.
    Hager, Jakob
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för kardiovaskulär medicin. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Centrum för kirurgi, ortopedi och cancervård, Kirurgiska kliniken ViN.
    Henriksson, Martin
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för hälso- och sjukvårdsanalys. Linköpings universitet, Medicinska fakulteten.
    Carlsson, Per
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för hälso- och sjukvårdsanalys. Linköpings universitet, Medicinska fakulteten.
    Länne, Toste
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för kardiovaskulär medicin. Region Östergötland, Hjärt- och Medicincentrum, Thorax-kärlkliniken i Östergötland. Linköpings universitet, Medicinska fakulteten.
    Lundgren, Fredrik
    Department of Surgery, Kalmar County Hospital, Kalmar, Sweden.
    Revisiting the cost-effectiveness of screening 65-year-old men for abdominal aortic aneurysm based on data from an implemented screening programme.2017Inngår i: International Journal of Angiology, ISSN 0392-9590, E-ISSN 1827-1839, Vol. 36, nr 6, s. 517-525Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    BACKGROUND: Health economic analyses based on randomized trials have shown that screening for abdominal aortic aneurysm (AAA) cost-effectively decreases AAA-related, as well as all- cause mortality. However, follow-up from implemented screening programmes now reveal substantially changed conditions in terms of prevalence, attendance rate, costs and mortality after intervention. Our aim was to evaluate whether screening for AAA among 65-year-old men is cost-effective based on contemporary data on prevalence and attendance rates from an ongoing AAA screening programme.

    METHODS: A decision-analytic model, previously used to analyse the cost-effectiveness of an AAA screening programme prior to implementation in clinical practice, was updated using data collected from an implemented screening programme as well as data from contemporary published data and the Swedish register for vascular surgery (Swedvasc).

    RESULTS: The base-case analysis showed that the cost per life-year gained and quality-adjusted life year (QALY) gained were €4832 and €6325, respectively. Based on conventional threshold values of cost-effectiveness, the probability of screening being cost-effective was high.

    CONCLUSION: Despite the reduction of AAA-prevalence and changes in AAA-management over time, screening 65-year-old men for AAA still appears to yield health outcomes at a cost below conventional thresholds of cost-effectiveness.

  • 2.
    Hager, Jakob
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för kardiovaskulär medicin. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Hjärt- och Medicincentrum, Thorax-kärlkliniken i Östergötland.
    Lundgren, Fredrik
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för kardiovaskulär medicin. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Hjärt- och Medicincentrum, Thorax-kärlkliniken i Östergötland.
    Population-based survival rate with a one- or two-stop referral pattern for patients with ruptured abdominal aortic aneurysms2013Inngår i: International Journal of Angiology, ISSN 0392-9590, E-ISSN 1827-1839, Vol. 32, nr 5, s. 492-500Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    AIM:

    Is there a difference in the population-based survival rate for patients with ruptured abdominal aortic aneurysms (rAAA), handled by a "one-stop" or a "two-stop" referral pattern?

    METHODS:

    Ten regions in Sweden were identified where clear-cut "one-stop" or "two-stop" referral-patterns prevailed. From the Swedvasc Registry we identified 849 patients operated on for rAAA, 1987 to 2004, living in any of these ten regions, and related the number of survivors to the whole population served by each hospital.

    RESULTS:

    The population-based survival rate was 14% lower for patients following a "two-stop" compared to a "one-stop" referral pattern (P=0.084). For the group 65-74 years-of-age the difference was significant (P=0.021), but no corresponding effect was seen regarding operative mortality rate or sex.

    CONCLUSION:

    Compared to a "one-stop" referral pattern for rAAA, a "two-stop" referral pattern results in a lower population-based survival rate for patients 65-74 years old, but the consequences would be small even if a "one-stop" referral pattern could be generally accomplished.

  • 3.
    Lundgren, Fredrik
    Linköpings universitet, Institutionen för medicin och hälsa, Fysiologi. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Hjärt- och Medicincentrum, Thorax-kärlkliniken i Östergötland.
    Does patency after a vein collar and PTFE-bypass depend on sex and age? Re-analysis of a randomised trial2012Inngår i: International Journal of Angiology, ISSN 0392-9590, E-ISSN 1827-1839, Vol. 31, nr 2, s. 156-162Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Aim. Randomized studies evaluating the effect of a vein collar at the distal anastomosis of PTFE-grafts show conflicting results. The study of the Joint Vascular Research Group (JVRG) of UK found improved primary patency while the Scandinavian Miller Collar Study (SCAMICOS) found neither any effect on patency nor on limb salvage after bypass to below-knee arteries. However, the Scandinavian patients were a decade older and predominately female compared to the British patients. Can this explain the conflicting result? less thanbrgreater than less thanbrgreater thanMethods: Primary patency with respect to sex, age and the use of vein collar were re-analysed in 345 patients from SCAMICOS with Kaplan-Meier life-table technique, log-rank test and Cox proportional hazards regression to evaluate any interaction between sex or age and the effect of a vein collar on the primary patency rate. less thanbrgreater than less thanbrgreater thanResults. Females had better patency than males (log-rank test, chi(2)=9.4, df=1, P=0.002) but age had no influence on patency (log-rank test, chi(2)=3.3, df=3, P=0.35). However, 47% of the males compared to 23% of the females were smokers (P=0.00002). No interaction effect between sex and vein collar (P-value=0.224) or age and vein collar (P-value=0527) was established. less thanbrgreater than less thanbrgreater thanConclusion. The difference between the two randomised vein collar studies are unlikely to depend on the disparity in sex and age of the study populations.

  • 4.
    Lundgren, Fredrik
    Scandinavian Miller Collar Study, Sweden.
    The effect on patency of type, shape and volume of a vein collar used at the distal anastomis of PTFE-bypass to arteries below-knee2012Inngår i: International Journal of Angiology, ISSN 0392-9590, E-ISSN 1827-1839, Vol. 31, nr 4, s. 348-355Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    AIM:

    The aim of this paper was to study the effect on patency rate of different types of vein collar (Miller's original or St Mary's boot), different length/height shapes of vein collar, and different vein collar volumes at the distal anastomosis of PTFE-bypass grafts to below-knee arteries in patients with critical limb ischemia.

    METHODS:

    One hundred eighty patients operated on with PTFE-bypass to below-knee arteries with a vein collar at the distal anastomosis were analyzed. They were recruited from a prospective randomized trial evaluating the effect of adding a vein collar to the distal anastomosis. Primary patency rate of the reconstructions were assessed against three factors: the type, shape, and volume of the vein collar. Univariate analysis was performed with the help of plotted Kaplan-Meier lifetable curves and log-rank tests and multivariate analysis with Cox proportional hazards regression.

    RESULTS:

    Type of vein collar had no influence on primary patency (logrank-test, χ(2)=0.8, df=1, P=0.377, N.=180). A length/height ratio of the vein collar between 1.18 and 1.63 were advantageous for primary patency but the effect was not statistically significant (logrank-test, chisq=5.5, df=2, P=0.063, N.=177). A large volume of the vein collar enhanced primary patency (logrank-test, chisq=6, df=2, P=0.050, N.=173). In the multivariate analysis, however, a larger volume and a length/height ratio between 1.18 and 1.63 as well as > 1.63 reduce the risk of graft failure with 48% (P=0.00006), 58% (P=0.007), 58% (P=0.004), respectively, while vein collar type had no effect on primary patency.

    CONCLUSION:

    This prospective observational study indicates that if a vein collar is used at the distal anastomosis of a PTFE-bypass to below-knee arteries it should be long compared to height and large in volume to improve primary patency rate, while the type of vein collar does not appear to matter.

  • 5.
    Lundgren, Fredrik
    Linköpings universitet, Institutionen för medicin och hälsa, Fysiologi. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Hjärt- och Medicincentrum, Thorax-kärlkliniken i Östergötland.
    The vein collar: an anastomotic servant or a patency promoter? Re-analysis of a randomized trial2012Inngår i: International Journal of Angiology, ISSN 0392-9590, E-ISSN 1827-1839, Vol. 31, nr 3, s. 234-238Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Aim. Randomized studies evaluating the effect of a vein collar at the distal anastomosis of PTFE-grafts show conflicting results. The study of the Joint Vascular Research Group (JVRG) of UK found improved primary patency while the Scandinavian Miller Collar Study (SCAMICOS) found neither any effect on patency nor on limb salvage after bypass to below-knee arteries. It has been discussed whether the questioned positive effect of a vein collar is due to technical advantages when the anastomosis is made rather than on a positive influence on the long-term effect by less pseudointima formation. less thanbrgreater than less thanbrgreater thanMethods. Primary patency regarding the use of vein collar were re-analyzed in 345 patients from SCAMICOS with Kaplan-Meier life-table technique and Cox proportional hazards regression in a counting process notation to evaluate any interaction between time-period and the effect of a vein collar on the primary patency rate. less thanbrgreater than less thanbrgreater thanResults. No overall effect on primary patency of a vein collar at the distal anastomosis was found irrespective of the site anastomosis. However, during the first 30 days of follow-up the primary patency among the femoro-crural bypasses was 0.87 (0.79-0.95) and 0.72 (0.63-0.83) with and without vein collar respectively. The interaction between vein collar and time-period was not statistically significant (P=0.070) and neither was the Score test for the whole interaction analysis (P=0.091) for the patients with anastomosis to the crural arteries. No such initial differences were found for the patients with anastomosis to the popliteal artery below-knee. less thanbrgreater than less thanbrgreater thanConclusion. A clinically relevant but not statistically significant better primary patency during the first 30 days was found for patients with PTFE-bypass to the crural arteries with a vein collar at the distal anastomosis. There were no long-term advantages of the vein collar irrespective of the location of the anastomosis.

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