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  • 1.
    Borch, Kurt
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Biomedicine and Surgery, Surgery. Östergötlands Läns Landsting, MKC-2, GE: Gastrokir.
    Jönsson, Björn
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Vascular surgery. Östergötlands Läns Landsting, Heart Centre, Department of Thoracic and Vascular Surgery.
    Tarpila, Erkki
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Biomedicine and Surgery, Plastic Surgery, Hand Surgery and Burns. Östergötlands Läns Landsting, Reconstruction Centre, Department of Plastic Surgery, Hand surgery UHL.
    Franzén, Thomas
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Biomedicine and Surgery, Surgery. Östergötlands Läns Landsting, MKC-2, GE: Gastrokir.
    Berglund, J
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Vascular surgery. Östergötlands Läns Landsting, Heart Centre, Department of Thoracic and Vascular Surgery.
    Kullman, Eric
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Biomedicine and Surgery, Surgery. Östergötlands Läns Landsting, MKC-2, GE: Gastrokir.
    Franzén, L
    Changing pattern of histological type, location, stage and outcome of surgical treatment of gastric carcinoma2000In: British Journal of Surgery, ISSN 0007-1323, E-ISSN 1365-2168, Vol. 87, no 5, p. 618-626Article in journal (Refereed)
    Abstract [en]

    Background: There are indications that some features of gastric carcinoma are changing, with a possible impact on prognosis. The aim of this study was to examine any changes in type, location, stage, resection rate, postoperative mortality rate or prognosis for patients with gastric carcinoma in a well defined population. Methods: During 1974-1991, 1161 new cases of gastric adenocarcinoma were diagnosed in Ostergotland County, Sweden. Tumour location, Lauren histological type, tumour node metastasis (TNM) stage, radicality of tumour resection and postoperative complications were recorded after histological re-evaluation of tissue specimens and examination of all patient records. Dates of death were obtained from the Swedish Central Bureau of Statistics. Time trends were studied by comparing the intervals 1974-1982 (period 1) and 1983-1991 (period 2). Results: The proportion of diffuse type of adenocarcinoma increased (from 27 to 35 per cent), while that of mixed type decreased (from 16 to 9 per cent) and that of intestinal type was unchanged. The proportion of tumours located in the proximal two-thirds of the stomach increased (from 32 to 42 per cent) and the proportion of patients with tumours in TNM stage IV decreased (from 32 to 25 per cent). Overall tumour resection rates were unchanged, although the proportion of radical total gastrectomies increased (from 36 to 50 per cent). Excluding tumours of the cardia or gastric remnant after previous ulcer surgery, the 5-year relative survival rate after radical resection increased from 25 to 36 per cent and the postoperative mortality rate decreased for both radical (from 11 to 4 per cent) and palliative (from 18 to 6 per cent) resection. Conclusion: The patterns of tumour histology, location and stage of gastric carcinoma have changed in the authors' region. These changes were paralleled by a significant improvement in survival and postoperative mortality rates.

  • 2.
    Brodszki, J
    et al.
    Lund.
    Länne, Toste
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Vascular surgery. Östergötlands Läns Landsting, Heart Centre, Department of Thoracic and Vascular Surgery.
    Stale, H
    Lund.
    Batra, S
    Lund.
    Marsal, K
    Lund.
    Altered vascular function in healthy normotensive pregnant women with bilateral uterine artery notches2002In: British Journal of Obstetrics and Gynecology, ISSN 1470-0328, E-ISSN 1471-0528, Vol. 109, no 5, p. 546-552Article in journal (Refereed)
    Abstract [en]

    Objectives: To assess endothelial function and vascular mechanical properties in normotensive pregnant women with high resistance in the uteroplacental circulation. Design: Cross-sectional prospective study. Setting: Doppler ultrasound laboratory at university department of obstetrics and gynaecology referral centre for high risk pregnancies. Participants: Forty-two caucasian normotensive pregnant women: 23 with uncomplicated pregnancies and 19 with bilateral uterine artery notches. Methods: Flow-mediated dilatation of the brachial artery was measured by ultrasonography at 25 gestational weeks. Concentrations of nitrite and nitrate in the plasma were established at 25 and 32 gestational weeks. The elastic properties of the common carotid artery, abdominal aorta and popliteal artery were measured with an ultrasonic echo-tracking system. Results: Flow-mediated dilatation at two minutes after cuff deflation was significantly lower in the bilateral notch group compared with the control group, 8.3% and 13.7%, respectively (P = 0.0007). The ability to sustain vasodilatation was reduced in the bilateral notch group (P = 0.02). Lower values of nitrite and nitrate in the plasma were found at 32 gestational weeks in the bilateral notch group than in the control group (mean 24.76 ╡M/ L (SD 5.6) and 30.93 ╡M/L (8.2), respectively, P = 0.008). Nitrite and nitrate levels tended to be lower in the bilateral notch group even at 25 gestational weeks (29.45 ╡M/L (8.3) and 35.73 ╡M/L (11.0) in the bilateral notch and control group, respectively, P = 0.09). There was no difference in aortic, carotid or popliteal elasticity between the two groups. Conclusions: Healthy normotensive pregnant women with bilateral uterine artery notches show impaired endothelial function, but no differences in vascular mechanical properties.

  • 3.
    Elfström, J
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Vascular surgery. Östergötlands Läns Landsting, Heart Centre, Department of Thoracic and Vascular Surgery.
    Rutberg, Hans
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Thoracic Surgery. Östergötlands Läns Landsting, Heart Centre, Department of Thoracic and Vascular Surgery.
    Samverkan kan frigöra pengar till vården2002In: Dagens medicin : oberoende nyhetstidning för hela sjukvården, ISSN 1104-7488, Vol. 6, p. 46-46Article in journal (Other (popular science, discussion, etc.))
  • 4.
    Elfström, Johan
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Vascular surgery. Östergötlands Läns Landsting, Heart Centre, Department of Thoracic and Vascular Surgery.
    Resultat av kärlkirurgi hos de allra äldsta. Kostnaderna jämförbara med dem för yngre patienter.2000In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 97, p. 4292-4297Article in journal (Other academic)
  • 5.
    Elfström, Johan
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Vascular surgery. Östergötlands Läns Landsting, Heart Centre, Department of Thoracic and Vascular Surgery.
    Bergqvist, David
    Skau, Tommy
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Vascular surgery. Östergötlands Läns Landsting, Heart Centre, Department of Thoracic and Vascular Surgery.
    Lovande början på kärlkirurgins arbete med kvalitetsindikatorer2002In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 99, p. 4366-4399Article in journal (Other academic)
  • 6.
    Forsell, Claes
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Vascular surgery. Östergötlands Läns Landsting, Heart Centre, Department of Thoracic and Vascular Surgery.
    Graft flow enhancement by intermittent foot compression2002In: Svensk kirurgi,2002, 2002, p. 159-159Conference paper (Refereed)
  • 7.
    Granfeldt, Hans
    et al.
    Linköping University, Department of Medical and Health Sciences, Thoracic Surgery. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart Centre, Department of Thoracic and Vascular Surgery.
    Bansi, Bansi
    Linköping University, Department of Biomedical Engineering, Medical Informatics. Linköping University, Faculty of Health Sciences.
    Wiklund, Lars
    University Hospital, Lund, Sweden.
    Peterzén, Bengt
    Linköping University, Department of Medical and Health Sciences, Vascular surgery. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart Centre, Department of Thoracic and Vascular Surgery.
    Lönn, Urban
    University Hospital, Gothenburg, Sweden.
    Babic, Ankica
    University Hospital, Uppsala, Sweden.
    Ahn, Henrik
    Linköping University, Department of Medicine and Care, Vascular surgery. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart Centre, Department of Thoracic and Vascular Surgery.
    Risk Factor Analysis of Swedish Left Ventricular Assist Device (LVAD) Patients2003In: Annals of Thoracic Surgery, ISSN 0003-4975, E-ISSN 1552-6259, Vol. 76, no 6, p. 1993-1998Article in journal (Refereed)
    Abstract [en]

    Background. The use of left ventricular assist devices (LVADs) is established as a bridge to heart transplantation. Methods. All Swedish patients on the waiting list for heart transplantation, treated with LVAD since 1993 were retrospectively collected into a database and analyzed in regards to risk factors for mortality and morbidity. Results. Fifty-nine patients (46 men) with a median age of 49 years (range, 14 to 69 years), Higgins score median of 9 (range, 3 to 15), EuroScore median of 10 (range, 5 to 17) were investigated. Dominating diagnoses were dilated cardiomyopathy in 61% (n = 36) and ischemic cardiomyopathy in 18.6% (n = 11). The patients were supported with LVAD for a median time of 99.5 days (range, 1 to 873 days). Forty-five (76%) patients received transplants, and 3 (5.1%) patients were weaned from the device. Eleven patients (18.6%) died during LVAD treatment. Risk factor analysis for mortality before heart transplantation showed significance for a high total amount of autologous blood transfusions (p < 0.001), days on mechanical ventilation postoperatively (p < 0.001), prolonged postoperative intensive care unit stay (p = 0.007), and high central venous pressure 24 hours postoperatively and at the final measurement (p = 0.03 and 0.01, respectively). Mortality with LVAD treatment was 18.6% (n = 11). High C-reactive protein (p = 0.001), low mean arterial pressure (p = 0.03), and high cardiac index (p = 0.03) preoperatively were risk factors for development of right ventricular failure during LVAD treatment. Conclusions. The Swedish experience with LVAD as a bridge to heart transplantation was retrospectively collected into a database. This included data from transplant and nontransplant centers. Figures of mortality and morbidity in the database were comparable to international experience. Specific risk factors were difficult to define retrospectively as a result of different protocols for follow-up among participating centers. © 2003 by The Society of Thoracic Surgeons.

  • 8.
    Hager, Jakob
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Thoracic Surgery. Östergötlands Läns Landsting, Heart Centre, Department of Thoracic and Vascular Surgery.
    Lundgren, Fredrik
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Vascular surgery. Östergötlands Läns Landsting, Heart Centre, Department of Thoracic and Vascular Surgery.
    Forssell, Claes
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Thoracic Surgery. Östergötlands Läns Landsting, Heart Centre, Department of Thoracic and Vascular Surgery.
    FranzÉn, Stefan
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Thoracic Surgery. Östergötlands Läns Landsting, Heart Centre, Department of Thoracic and Vascular Surgery.
    Hermansson, Ulf
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Thoracic Surgery. Östergötlands Läns Landsting, Heart Centre, Department of Thoracic and Vascular Surgery.
    Isaksson, Lars
    Vanhanen, Ingemar
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Thoracic Surgery. Östergötlands Läns Landsting, Heart Centre, Department of Thoracic and Vascular Surgery.
    Surgery for descending and thoracoabdominal aortic aneurysms2005In: Kardiovaskulära vårmötet,2005, 2005Conference paper (Other academic)
  • 9.
    Henriksson, Martin
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Department of Health and Society, Center for Medical Technology Assessment.
    Lundgren, Fredrik
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Vascular surgery. Östergötlands Läns Landsting, Heart Centre, Department of Thoracic and Vascular Surgery.
    Modelling the cost-effectiveness of screening for abdominal aortic aneurysm and assessing the value of further research2005In: IHEA,2005, 2005Conference paper (Refereed)
  • 10.
    Henriksson, Martin
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Department of Health and Society, Center for Medical Technology Assessment.
    Lundgren, Fredrik
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Vascular surgery. Östergötlands Läns Landsting, Heart Centre, Department of Thoracic and Vascular Surgery.
    One-time Screening of Abdominal Aortic Aneurysm in 65-year-old Men2005Report (Other academic)
  • 11. Isaksson, L
    et al.
    Lundgren, Fredrik
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Vascular surgery. Östergötlands Läns Landsting, Heart Centre, Department of Thoracic and Vascular Surgery.
    Prognostic factors for failure of primary patency within a year of bypass to the foot in patients with diabetes and critical ischaemia2000In: European Journal of Surgery, ISSN 1102-4151, E-ISSN 1741-9271, Vol. 166, no 2, p. 123-128Article in journal (Refereed)
    Abstract [en]

    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.

  • 12.
    Jönsson, Björn
    Linköping University, Department of Medicine and Care, Vascular surgery. Linköping University, Faculty of Health Sciences.
    On leg ischaemia: aspects of epidemiology and diagnostics2005Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    The first part of this thesis consists of a population-based epidemiological study on symptomatic leg arterial disease in a Swedish community, based on a postal questionnaire and systolic ankle pressure measurements, with calculation of the ankle-brachial pressure index (ABPI; usually ≥ 1.0 in healthy subjects). The second part investigates alternative methods for ankle systolic pressure measurements, with the potential of automation.

    (Papers I-III) A postal questionnaire on leg symptoms and concomitant diseases was distributed to all the inhabitants of Vadstena 50-89 years old (n=7,524). The response rate was 92% and of those reporting any leg pain, 80% (353/441) attended an examination with ABPI determination. Symptomatic leg ischaemia (SLI) was defined as leg pain on walking + ABPI ≤ 0.8. The prevalence was 4.1 %, increasing with age, with no major difference between men and women. Other manifestations of arteriosclerotic disease (previous angina pectoris, myocardial infarction or cerebrovascular incident), hypertension and diabetes mellitus were more prevalent among SLI cases than in healthy subjects. At a four-year follow-up, the age and sex adjusted mortality ratio was almost doubled in SLI subjects. Their relative risk of a myocardial infarction, cardiac death and death due to any cardiovascular event was 2.7, 2.0 and 1.9, respectively, compared to an age and sex matched control group. In SLI subjects without a previous history of ischaemic heart disease, the relative risk of a myocardial infarction was 3.1. Cardiovascular disease alone was mainly responsible for the increased risk of death. At a ten-year follow-up, a baseline ABPI up to 0.8 was inversely correlated with mortality. In a Cox regression model, a low ABPI was significantly and independently associated with an increased risk of death. An ABPI of 0.81-0.99 was not associated with an increased mortality risk. Over ten years, 1/7 of the SLI cases had a leg vascular reconstructive procedure, the majority within the first two years, and 1/14 underwent a major amputation. In conclusion, in spite of the good prognosis of the local disease, SLI can be looked upon as a marker for generalised arteriosclerotic disease and as a risk predictor for severe arteriosclerotic events and premature death.

    (Papers IV-VI) Oscillometric technique, commonly used for automatic arm blood pressure measurements, was validated against the CW Doppler in systolic ankle pressure determination in healthy subjects and in patients with leg arterial disease. While performing adequately in healthy subjects, it was found to be invalid in leg arterial disease. The oscillometric technique was deemed as not suitable for use as an automatic ankle pressure recorder in the diagnosis ofleg arteriosclerotic disease.

    A new technique, based on a two-channel photoplethysmographic (PPG) probe (880nm) placed underneath the pneumatic cuff, together with electronics, was developed and compared with both CW Doppler and intra-arterial recordings in subjects without vascular disease, and with the CW Doppler in leg arterial disease. On visual analysis of the PPG curves, the agreement was good. An automatic algorithm for analysis of PPG-data gave comparable results. The PPG method is a promising technique for future automation of systolic ankle pressure measurements, and for inclusion in a complete ABPI recorder.

    List of papers
    1. Prevalence of symptomatic leg ischaemia in a swedish community: an epidemiological study
    Open this publication in new window or tab >>Prevalence of symptomatic leg ischaemia in a swedish community: an epidemiological study
    1993 (English)In: European Journal of Vascular Surgery (United Kingdom), ISSN 0950-821X, Vol. 7, no 4, p. 432-437Article in journal (Refereed) Published
    Abstract [en]

    The prevalence of symptomatic leg ischaemia (SLI) was studied using a standardised postal questionnaire and by measuring ankle systolic blood pressure among those with leg pain. All individuals, aged 50–89 years, of both sexes (n = 2748) in a community of 7524 inhabitants were included. The overall questionnaire response rate was 92%, of whom 441 (17%) reported any form of leg pain. Ankle systolic blood pressure (ASBP) was measured in 353 (80%) of those. Ankle/brachial index (ABI) ⩽0.8 was chosen as the criterion for verified SLI. One hundred and seven (30%) had a verified SLI (ABI ⩽0.8).Hospital records could be reviewed in 83% of the non-responders, and revealed corresponding distributions of risk factors among the non-responders and the questionnaire-responders. Risk factor frequencies among ASBP-examined and not examined individuals were also comparable. The overall prevalence of SLI in the age 50–89 years was 4.1%, ranging from 1.5% in the age decade of 50–59 years, to maximum 7.1% in the decade 70–79 years. A slight but not significant male predominance was recorded, except for the age decade 70–79 years. The prevalence of SLI in the whole community population was approximately 2000/100 000 of which 5% were possible candidates for vascular intervention.

    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-84282 (URN)10.1016/S0950-821X(05)80262-2 (DOI)
    Available from: 2012-10-03 Created: 2012-10-03 Last updated: 2012-10-03Bibliographically approved
    2. Outcome of symptomatic leg ischaemia: four year morbidity and mortality in vadstena, Sweden
    Open this publication in new window or tab >>Outcome of symptomatic leg ischaemia: four year morbidity and mortality in vadstena, Sweden
    1996 (English)In: European Journal of Vascular and Endovascular Surgery, ISSN 1078-5884, E-ISSN 1532-2165, Vol. 11, no 3, p. 315-232Article in journal (Refereed) Published
    Abstract [en]

    Objective:

    To quantify cardiovascular morbidity and mortality including the incidence of vascular surgery and amputations, among individuals with symptomatic leg ischaemia.

    Design:

    Prospective cohort study.

    Material:

    Inhabitants 50–89 years of age (n = 2784) of Vadstena community, Östergötland, Sweden, with 4 years of follow-up. 107 subjects with symptomatic leg ischaemia (SLI), selected by a postal questionnaire and ankle pressure measurements, and an age and sex matched control group of 214 individuals.

    Chief outcome measures:

    Cardiovascular morbidity and mortality, all cause mortality, surgical procedures for leg ischaemia, major amputations, ankle brachial pressure index.

    Main results:

    Age and sex adjusted all-cause mortality risk in the SLI-group was increased by 1.9. This was most prominent among men in their sixties and women in their seventies. Cardiovascular mortality was increased by 1.9 (95% confidence interval 1.1–3.3). Relative risks for acute myocardial infarction and cerebrovascular events were 2.4 (1.1–5.1) and 1.7 (0.9–3.2), respectively. The increase in age and sex adjusted incidence of primary reconstructive surgery during the first year after initial examination was 67-fold compared to the total population of Vadstena 50–89 years old, and 18-fold for the whole observation period, while the increase in risk for major amputation during the observation period was 12-fold. Median ankle brachial index improved significantly during follow-up among the individuals alive and not subjected to vascular surgery.

    Conclusions:

    Among the SLI-subjects identified in a general population, the overall risk for cardiovascular morbidity and mortality over 4 years was significantly increased compared to normals.

    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-84284 (URN)10.1016/S1078-5884(96)80078-5 (DOI)
    Available from: 2012-10-03 Created: 2012-10-03 Last updated: 2017-12-07Bibliographically approved
    3. Ankle-brachial index and mortality in a cohort of questionnaire recorded leg pain on walking
    Open this publication in new window or tab >>Ankle-brachial index and mortality in a cohort of questionnaire recorded leg pain on walking
    2002 (English)In: European Journal of Vascular and Endovascular Surgery, ISSN 1078-5884, E-ISSN 1532-2165, Vol. 24, no 5, p. 405-410Article in journal (Refereed) Published
    Abstract [en]

    Objective: to study the association between the ankle–brachial pressure index (ABPI), premature death and the need for surgical treatment for lower limb ischaemia.

    Design: population based cohort study.

    Subjects: three hundred and fifty-three men and women, 50–89 years old, underwent a leg pain questionnaire and measurement of ABPI and was then followed for 10 years.

    Outcome Measures: all cause mortality, vascular procedures and major amputations.

    Results: a low ABPI was independently associated with premature all cause mortality in the multiple regression analysis, carrying a relative risk of 3.4 (95% confidence interval 2.0–5.9) and 2.1 (1.3–3.3) for ABPIs ≤0.50 and 0.51–0.80, respectively, compared to those with ABPI ≥1.0. Individuals with an ABPI in the interval 0.81–0.99 suffered only a slight, not statistically significant risk increase compared to normals. A low ABPI at baseline implied a continuous constant increased risk of death throughout the study period. The same risk was observed among elderly (70–89, median 77 years), and in the middle aged (50–69, median 63 years) individuals. The vast majority of those subjected to vascular intervention or major amputation during follow-up had an ABPI≤0.8 at baseline (83 and 89%, respectively). However, within that group, the individual ABPI was not predictive for surgical intervention.

    Conclusion: the association found between an ABPI ≤0.8 and premature mortality in this cohort of symptomatic subjects implies that the ABPI is a powerful, independent predictor for premature death. The prognostic information carried by an ABPI in the interval 0.81–0.99 remains uncertain. Septuagenarians and octogenarians carry the same risk increase associated with a low ABPI as those in the middle ages.

    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-26965 (URN)10.1053/ejvs.2002.1747 (DOI)11598 (Local ID)11598 (Archive number)11598 (OAI)
    Available from: 2009-10-08 Created: 2009-10-08 Last updated: 2017-12-13Bibliographically approved
    4. Is oscillometric ankle pressure reliable in leg vascular disease?
    Open this publication in new window or tab >>Is oscillometric ankle pressure reliable in leg vascular disease?
    2001 (English)In: Clinical Physiology and Functional Imaging, ISSN 1475-0961, E-ISSN 1475-097X, Vol. 21, no 2, p. 155-163Article in journal (Refereed) Published
    Abstract [en]

    The objective of the study was to evaluate the validity of oscillometric systolic ankle pressure in symptomatic leg arterial occlusive disease. Ankle pressure measurements using oscillometric curves obtained using a standard 12-cm cuff with a specially designed device for signal processing were validated against the continuous wave (CW) Doppler technique. Thirty-four subjects without signs or symptoms of peripheral vascular disease (68 legs) and 47 patients with leg ischaemia (85 legs) varying from moderate claudication to critical ischaemia were examined. The oscillometric curves were analysed using several algorithms reported in the literature, based on the assumption that maximum oscillations are recorded near mean arterial pressure. In normals, reasonable agreement between CW Doppler and oscillometric methods was seen. When an algorithm that determined the lowest cuff pressure at which maximum oscillations occurred, and a characteristic ratio for systolic pressure of 0·52 was used, the mean difference between CW Doppler and oscillometry was 1·7 mmHg [range −19 to +27, limits of agreement (2 SD) 21·1 mmHg]. In ischaemic legs, oscillometry overestimated systolic ankle pressure by a mean of 28·8 mmHg [range –126 to +65, limits of agreement 82·8 mmHg]. The difference was more pronounced among patients with critical ischaemia compared with claudicants, and also more evident among diabetics. The error of oscillometric pressure determination in subjects with leg arterial disease inversely increased with CW Doppler ankle pressure. In 39% of the recordings in legs with a CW Doppler systolic pressure below 100 mmHg, the oscillometric mean arterial pressure was higher than the recorded CW Doppler systolic pressure. In conclusion, the oscillometric method to determine systolic ankle pressure, based on the concept of maximum cuff oscillations occurring near mean arterial pressure, is not reliable in leg arterial disease, usually overestimating ankle pressure.

    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-26714 (URN)10.1046/j.1365-2281.2001.00314.x (DOI)11308 (Local ID)11308 (Archive number)11308 (OAI)
    Available from: 2009-10-08 Created: 2009-10-08 Last updated: 2017-12-13Bibliographically approved
    5. A new probe for ankle systolic pressure measurement using Photoplethysmography (PPG)
    Open this publication in new window or tab >>A new probe for ankle systolic pressure measurement using Photoplethysmography (PPG)
    2005 (English)In: Annals of Biomedical Engineering, ISSN 0090-6964, E-ISSN 1573-9686, Vol. 33, no 2, p. 232-239Article in journal (Refereed) Published
    Abstract [en]

    An automated method for ankle systolic pressure measurement, less operator dependent than the standard continuous wave (CW) Doppler technique, would imply an advantage both in patient measurements and in epidemiological studies. We present a new photoplethysmographic (PPG) probe that uses near-infrared light (880 nm) to detect pulsatory blood flow underneath the distal end of a standard pneumatic cuff. The probe is adapted to the anatomical conditions at the ankle, permitting recording of pressures in both ankle arteries separately. The validity of the equipment was tested with CW Doppler-derived systolic pressures and invasive blood pressure measurements for reference. In 20 healthy subjects, visual analysis of the PPG curves revealed a mean difference between CW Doppler and PPG measurements of –0.5 mmHg (SD 6.9). Corresponding results for the anterior and posterior tibial arteries separately were –1.8 mmHg (SD 6.2) and 0.9 mmHg (SD 7.3), respectively. A correct probe position was essential for the results. In direct recordings from the dorsalis pedis artery in 10 intensive care patients, PPG underestimated systolic pressure in the anterior tibial artery by 4.5 mmHg (SD 12.1). With further development, the PPG probe, integrated in the pneumatic cuff, may simplify measurements of ankle systolic pressures.

    Keywords
    near-infrared light, CW Doppler, leg, anterior tibial artery, posterior tibial artery, blood pressure determination
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-28919 (URN)10.1007/s10439-005-8982-7 (DOI)14122 (Local ID)14122 (Archive number)14122 (OAI)
    Available from: 2009-10-09 Created: 2009-10-09 Last updated: 2017-12-13Bibliographically approved
    6. Automatic ankle pressure measurements using PPG in ankle-brachial pressure index determination
    Open this publication in new window or tab >>Automatic ankle pressure measurements using PPG in ankle-brachial pressure index determination
    Show others...
    2005 (English)In: European Journal of Vascular and Endovascular Surgery, ISSN 1078-5884, E-ISSN 1532-2165, Vol. 30, no 4, p. 395-401Article in journal (Refereed) Published
    Abstract [en]

    Objective

    To evaluate a new technique using a photoplethysmographic (PPG) probe for automatic ankle pressure measurements.

    Design

    Comparative study on two techniques for ankle pressure measurement.

    Setting

    University hospital.

    Material

    Thirty-five patients with leg arterial disease and eight healthy volunteers. Ankle-brachial indices (ABPI) were measured using conventional CW Doppler technique and PPG-based prototype equipment for the ankle pressure recordings.

    Chief outcome measures

    ABPIs calculated from CW Doppler and PPG ankle pressure measurements. The PPG signals were analysed both by visual judgement and by a software based, automatic algorithm.

    Main results

    The mean difference between ABPIs calculated from CW Doppler recordings and PPG (visual analysis) was −0.01 (limits of agreement (±two standard deviations) +0.16 to −0.19). The correlation coefficient was 0.93. When the algorithm was used, the mean difference (CW Doppler−PPG) was 0.05 (limits of agreement 0.28 to −0.18, r=0.89).

    Conclusions

    The PPG method is a promising technique with an inherent potential for automatisation of the ankle pressure measurements, thereby reducing the observer-dependency in ABPI recordings.

    Keywords
    photoplethysmography, ankle, blood pressure determination, ultrasonography, Doppler
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-30084 (URN)10.1016/j.ejvs.2005.05.012 (DOI)15964772 (PubMedID)15552 (Local ID)15552 (Archive number)15552 (OAI)
    Available from: 2009-10-09 Created: 2009-10-09 Last updated: 2017-12-13Bibliographically approved
  • 13.
    Jönsson, Björn
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Vascular surgery. Östergötlands Läns Landsting, Heart Centre, Department of Thoracic and Vascular Surgery.
    Laurent, Claes
    Linköping University, The Institute of Technology. Linköping University, Department of Biomedical Engineering, Physiological Measurements.
    Eneling, Martin
    Linköping University, The Institute of Technology. Linköping University, Department of Biomedical Engineering, Physiological Measurements.
    Skau, Tommy
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Cardiology.
    Lindberg, Lars-Göran
    Linköping University, The Institute of Technology. Linköping University, Department of Biomedical Engineering, Physiological Measurements.
    Automatic ankle pressure measurements using PPG in ankle-brachial pressure index determination2005In: Scandinavian Cardiovascular Journal,2005, Sweden: Taylor & Francis , 2005, p. 13-Conference paper (Refereed)
  • 14.
    Jönsson, Björn
    et al.
    Linköping University, Department of Medicine and Care, Vascular surgery. Linköping University, Department of Medicine and Care, Anaesthesiology. Linköping University, Faculty of Health Sciences.
    Laurent, Claes
    Linköping University, Department of Biomedical Engineering. Linköping University, The Institute of Technology.
    Eneling, Martin
    Linköping University, Department of Biomedical Engineering. Linköping University, The Institute of Technology.
    Skau, Tommy
    Linköping University, Department of Medicine and Care, Vascular surgery. Linköping University, Faculty of Health Sciences.
    Lindberg, Lars-Göran
    Linköping University, Department of Biomedical Engineering. Linköping University, The Institute of Technology.
    Automatic ankle pressure measurements using PPG in ankle-brachial pressure index determination2005In: European Journal of Vascular and Endovascular Surgery, ISSN 1078-5884, E-ISSN 1532-2165, Vol. 30, no 4, p. 395-401Article in journal (Refereed)
    Abstract [en]

    Objective

    To evaluate a new technique using a photoplethysmographic (PPG) probe for automatic ankle pressure measurements.

    Design

    Comparative study on two techniques for ankle pressure measurement.

    Setting

    University hospital.

    Material

    Thirty-five patients with leg arterial disease and eight healthy volunteers. Ankle-brachial indices (ABPI) were measured using conventional CW Doppler technique and PPG-based prototype equipment for the ankle pressure recordings.

    Chief outcome measures

    ABPIs calculated from CW Doppler and PPG ankle pressure measurements. The PPG signals were analysed both by visual judgement and by a software based, automatic algorithm.

    Main results

    The mean difference between ABPIs calculated from CW Doppler recordings and PPG (visual analysis) was −0.01 (limits of agreement (±two standard deviations) +0.16 to −0.19). The correlation coefficient was 0.93. When the algorithm was used, the mean difference (CW Doppler−PPG) was 0.05 (limits of agreement 0.28 to −0.18, r=0.89).

    Conclusions

    The PPG method is a promising technique with an inherent potential for automatisation of the ankle pressure measurements, thereby reducing the observer-dependency in ABPI recordings.

  • 15.
    Jönsson, Björn
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Vascular surgery. Östergötlands Läns Landsting, Heart Centre, Department of Thoracic and Vascular Surgery.
    Laurent, Claes
    Linköping University, The Institute of Technology. Linköping University, Department of Biomedical Engineering, Physiological Measurements.
    Eneling, Martin
    Linköping University, The Institute of Technology. Linköping University, Department of Biomedical Engineering, Physiological Measurements.
    Skau, Tommy
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Cardiology.
    Lindberg, Lars-Göran
    Linköping University, The Institute of Technology. Linköping University, Department of Biomedical Engineering, Physiological Measurements.
    Automatisk ankeltryckmätning med PPG för bestämning av ankel-armindex (ABP)2005In: Svensk Kirurgi,2005, 2005, p. 23-Conference paper (Refereed)
  • 16.
    Jönsson, Björn
    et al.
    Linköping University, Department of Medicine and Care, Vascular surgery. Linköping University, Faculty of Health Sciences.
    Laurent, Claes
    Linköping University, Department of Biomedical Engineering. Linköping University, The Institute of Technology.
    Skau, Tommy
    Linköping University, Department of Medicine and Care, Vascular surgery. Linköping University, Faculty of Health Sciences.
    Lindberg, Lars-Göran
    Linköping University, Department of Biomedical Engineering. Linköping University, The Institute of Technology.
    A new probe for ankle systolic pressure measurement using Photoplethysmography (PPG)2005In: Annals of Biomedical Engineering, ISSN 0090-6964, E-ISSN 1573-9686, Vol. 33, no 2, p. 232-239Article in journal (Refereed)
    Abstract [en]

    An automated method for ankle systolic pressure measurement, less operator dependent than the standard continuous wave (CW) Doppler technique, would imply an advantage both in patient measurements and in epidemiological studies. We present a new photoplethysmographic (PPG) probe that uses near-infrared light (880 nm) to detect pulsatory blood flow underneath the distal end of a standard pneumatic cuff. The probe is adapted to the anatomical conditions at the ankle, permitting recording of pressures in both ankle arteries separately. The validity of the equipment was tested with CW Doppler-derived systolic pressures and invasive blood pressure measurements for reference. In 20 healthy subjects, visual analysis of the PPG curves revealed a mean difference between CW Doppler and PPG measurements of –0.5 mmHg (SD 6.9). Corresponding results for the anterior and posterior tibial arteries separately were –1.8 mmHg (SD 6.2) and 0.9 mmHg (SD 7.3), respectively. A correct probe position was essential for the results. In direct recordings from the dorsalis pedis artery in 10 intensive care patients, PPG underestimated systolic pressure in the anterior tibial artery by 4.5 mmHg (SD 12.1). With further development, the PPG probe, integrated in the pneumatic cuff, may simplify measurements of ankle systolic pressures.

  • 17.
    Jönsson, Björn
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Vascular surgery. Östergötlands Läns Landsting, Heart Centre, Department of Thoracic and Vascular Surgery.
    Laurent, Claes
    Linköping University, The Institute of Technology. Linköping University, Department of Biomedical Engineering, Physiological Measurements.
    Skau, Tommy
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care.
    Lindberg, Lars-Göran
    Linköping University, The Institute of Technology. Linköping University, Department of Biomedical Engineering, Physiological Measurements.
    A new probe for ankle systolic pressure measurements using photopethysmography2004In: International Angiology,2004, 2004, p. 186-186Conference paper (Other academic)
  • 18.
    Jönsson, Björn
    et al.
    Linköping University, Department of Medicine and Care, Vascular surgery. Linköping University, Faculty of Health Sciences.
    Lindberg, Lars-Göran
    Linköping University, Department of Biomedical Engineering. Linköping University, Faculty of Health Sciences.
    Skau, Tommy
    Linköping University, Department of Medicine and Care, Vascular surgery. Linköping University, Faculty of Health Sciences.
    Thulesius, Olav
    Linköping University, Department of Medicine and Care, Clinical Physiology. Linköping University, Faculty of Health Sciences.
    Is oscillometric ankle pressure reliable in leg vascular disease?2001In: Clinical Physiology and Functional Imaging, ISSN 1475-0961, E-ISSN 1475-097X, Vol. 21, no 2, p. 155-163Article in journal (Refereed)
    Abstract [en]

    The objective of the study was to evaluate the validity of oscillometric systolic ankle pressure in symptomatic leg arterial occlusive disease. Ankle pressure measurements using oscillometric curves obtained using a standard 12-cm cuff with a specially designed device for signal processing were validated against the continuous wave (CW) Doppler technique. Thirty-four subjects without signs or symptoms of peripheral vascular disease (68 legs) and 47 patients with leg ischaemia (85 legs) varying from moderate claudication to critical ischaemia were examined. The oscillometric curves were analysed using several algorithms reported in the literature, based on the assumption that maximum oscillations are recorded near mean arterial pressure. In normals, reasonable agreement between CW Doppler and oscillometric methods was seen. When an algorithm that determined the lowest cuff pressure at which maximum oscillations occurred, and a characteristic ratio for systolic pressure of 0·52 was used, the mean difference between CW Doppler and oscillometry was 1·7 mmHg [range −19 to +27, limits of agreement (2 SD) 21·1 mmHg]. In ischaemic legs, oscillometry overestimated systolic ankle pressure by a mean of 28·8 mmHg [range –126 to +65, limits of agreement 82·8 mmHg]. The difference was more pronounced among patients with critical ischaemia compared with claudicants, and also more evident among diabetics. The error of oscillometric pressure determination in subjects with leg arterial disease inversely increased with CW Doppler ankle pressure. In 39% of the recordings in legs with a CW Doppler systolic pressure below 100 mmHg, the oscillometric mean arterial pressure was higher than the recorded CW Doppler systolic pressure. In conclusion, the oscillometric method to determine systolic ankle pressure, based on the concept of maximum cuff oscillations occurring near mean arterial pressure, is not reliable in leg arterial disease, usually overestimating ankle pressure.

  • 19.
    Jönsson, Björn
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Vascular surgery. Östergötlands Läns Landsting, Heart Centre, Department of Thoracic and Vascular Surgery.
    Skau, T
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Vascular surgery. Östergötlands Läns Landsting, Heart Centre, Department of Thoracic and Vascular Surgery.
    Lundgren, F
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Vascular surgery. Östergötlands Läns Landsting, Heart Centre, Department of Thoracic and Vascular Surgery.
    Aortoenteric fistula with aortic graft nfection - reconstruction of the abdominal aorta without a graft: a possible approach inb selected cases.1999In: European Journal of Surgery, ISSN 1102-4151, E-ISSN 1741-9271, Vol. 165, p. 1201-1202Article in journal (Refereed)
  • 20.
    Jönsson, Björn
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Vascular surgery. Östergötlands Läns Landsting, Heart Centre, Department of Thoracic and Vascular Surgery.
    Skau, Tommy
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Vascular surgery. Östergötlands Läns Landsting, Heart Centre, Department of Thoracic and Vascular Surgery.
    ABPI och mortalitet vid symtomgivande venischemi - en populationsbaserad studie med 10 års uppföljning. (Svensk kirurgi)2002In: Rapportklass C eller D samt Impactvärde 0,000 sätts om ISSN inte kan uppges.,2002, 2002Conference paper (Refereed)
  • 21.
    Jönsson, Björn
    et al.
    Linköping University, Department of Medicine and Care, Vascular surgery. Linköping University, Faculty of Health Sciences.
    Skau, Tommy
    Linköping University, Department of Medicine and Care, Vascular surgery. Linköping University, Faculty of Health Sciences.
    Ankle-brachial index and mortality in a cohort of questionnaire recorded leg pain on walking2002In: European Journal of Vascular and Endovascular Surgery, ISSN 1078-5884, E-ISSN 1532-2165, Vol. 24, no 5, p. 405-410Article in journal (Refereed)
    Abstract [en]

    Objective: to study the association between the ankle–brachial pressure index (ABPI), premature death and the need for surgical treatment for lower limb ischaemia.

    Design: population based cohort study.

    Subjects: three hundred and fifty-three men and women, 50–89 years old, underwent a leg pain questionnaire and measurement of ABPI and was then followed for 10 years.

    Outcome Measures: all cause mortality, vascular procedures and major amputations.

    Results: a low ABPI was independently associated with premature all cause mortality in the multiple regression analysis, carrying a relative risk of 3.4 (95% confidence interval 2.0–5.9) and 2.1 (1.3–3.3) for ABPIs ≤0.50 and 0.51–0.80, respectively, compared to those with ABPI ≥1.0. Individuals with an ABPI in the interval 0.81–0.99 suffered only a slight, not statistically significant risk increase compared to normals. A low ABPI at baseline implied a continuous constant increased risk of death throughout the study period. The same risk was observed among elderly (70–89, median 77 years), and in the middle aged (50–69, median 63 years) individuals. The vast majority of those subjected to vascular intervention or major amputation during follow-up had an ABPI≤0.8 at baseline (83 and 89%, respectively). However, within that group, the individual ABPI was not predictive for surgical intervention.

    Conclusion: the association found between an ABPI ≤0.8 and premature mortality in this cohort of symptomatic subjects implies that the ABPI is a powerful, independent predictor for premature death. The prognostic information carried by an ABPI in the interval 0.81–0.99 remains uncertain. Septuagenarians and octogenarians carry the same risk increase associated with a low ABPI as those in the middle ages.

  • 22.
    Jönsson, Björn
    et al.
    Linköping University, Department of Medicine and Care, Vascular surgery. Linköping University, Faculty of Health Sciences.
    Skau, Tommy
    Linköping University, Department of Medicine and Care, Vascular surgery. Linköping University, Faculty of Health Sciences.
    Outcome of symptomatic leg ischaemia: four year morbidity and mortality in vadstena, Sweden1996In: European Journal of Vascular and Endovascular Surgery, ISSN 1078-5884, E-ISSN 1532-2165, Vol. 11, no 3, p. 315-232Article in journal (Refereed)
    Abstract [en]

    Objective:

    To quantify cardiovascular morbidity and mortality including the incidence of vascular surgery and amputations, among individuals with symptomatic leg ischaemia.

    Design:

    Prospective cohort study.

    Material:

    Inhabitants 50–89 years of age (n = 2784) of Vadstena community, Östergötland, Sweden, with 4 years of follow-up. 107 subjects with symptomatic leg ischaemia (SLI), selected by a postal questionnaire and ankle pressure measurements, and an age and sex matched control group of 214 individuals.

    Chief outcome measures:

    Cardiovascular morbidity and mortality, all cause mortality, surgical procedures for leg ischaemia, major amputations, ankle brachial pressure index.

    Main results:

    Age and sex adjusted all-cause mortality risk in the SLI-group was increased by 1.9. This was most prominent among men in their sixties and women in their seventies. Cardiovascular mortality was increased by 1.9 (95% confidence interval 1.1–3.3). Relative risks for acute myocardial infarction and cerebrovascular events were 2.4 (1.1–5.1) and 1.7 (0.9–3.2), respectively. The increase in age and sex adjusted incidence of primary reconstructive surgery during the first year after initial examination was 67-fold compared to the total population of Vadstena 50–89 years old, and 18-fold for the whole observation period, while the increase in risk for major amputation during the observation period was 12-fold. Median ankle brachial index improved significantly during follow-up among the individuals alive and not subjected to vascular surgery.

    Conclusions:

    Among the SLI-subjects identified in a general population, the overall risk for cardiovascular morbidity and mortality over 4 years was significantly increased compared to normals.

  • 23.
    Laurent, Claes
    et al.
    Linköping University, The Institute of Technology. Linköping University, Department of Biomedical Engineering, Physiological Measurements.
    Jönsson, Björn
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Vascular surgery. Östergötlands Läns Landsting, Heart Centre, Department of Thoracic and Vascular Surgery.
    Vegfors, Magnus
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Anaesthesiology. Östergötlands Läns Landsting, Anaesthesiology and Surgical Centre, Department of Anaesthesiology and Intensive Care VHN.
    Eneling, M
    Lindberg, Lars-Göran
    Linköping University, The Institute of Technology. Linköping University, Department of Biomedical Engineering, Physiological Measurements.
    Nonivasive monitoring of systolic blood pressuire on the arm utilizing photoplethysmpgraphy (PPG)2004In: Proceedings of SPIE jfr 1998-2000 SPIE proceedings ISSN 1017-2653, ISSN 1605-7422, p. 99-107Article in journal (Refereed)
  • 24.
    Laurent, Claes
    et al.
    Linköping University, Department of Biomedical Engineering, Physiological Measurements. Linköping University, The Institute of Technology.
    Jönsson, Björn
    Linköping University, Department of Medicine and Care, Vascular surgery. Östergötlands Läns Landsting, Heart Centre, Department of Thoracic and Vascular Surgery. Linköping University, Faculty of Health Sciences.
    Vegfors, Magnus
    Linköping University, Department of Medicine and Care, Anaesthesiology. Linköping University, Faculty of Health Sciences.
    Eneling, Martin
    Linköping University, Department of Biomedical Engineering. Linköping University, The Institute of Technology.
    Lindberg, Lars-Göran
    Linköping University, Department of Biomedical Engineering, Physiological Measurements. Linköping University, The Institute of Technology.
    Noninvasive monitoring of systolic blood pressure on the arm utilizing photoplethysmography (PPG): clinical report2004In: Proc. SPIE 5318, Advanced Biomedical and Clinical Diagnostic Systems II / [ed] Gerald E. Cohn; Warren S. Grundfest; David A. Benaron; Tuan Vo-Dinh, Bellingham WA, USA: SPIE , 2004, p. 99-Conference paper (Refereed)
    Abstract [en]

    A soft (silicone) probe, containing six light emitting diodes (880 nm) and three photo detectors, utilizes photoplethysmography (PPG) to monitor pulsations from the brachialis artery under an occluding cuff during deflation. When the arterial pulse returns, measured by PPG, the corresponding pressure in the cuff is determined. This pressure is assumed to equal the systolic pressure. An assessment trial was performed on 21 patients (9 women and 12 men, aged 27-69) at the Neuro-Intensive care unit. Since the patients were already provided with arterial needles, invasive blood pressure could be used as the reference. By choosing a threshold, for detecting pulses, as a fraction (4%) of the maximum amplitude, the systolic blood pressure was underestimated (-0.57 mmHg, SD 12.1). The range of systolic pressure for the patients was 95.5 - 199.0 mmHg, n=14. The method is promising, but improvements still have to be made in order to improve the technique.

  • 25.
    Laurent, Claes
    et al.
    Linköping University, Department of Biomedical Engineering, Physiological Measurements. Linköping University, The Institute of Technology.
    Jönsson, Björn
    Linköping University, Department of Medicine and Care, Vascular surgery. Östergötlands Läns Landsting, Heart Centre, Department of Thoracic and Vascular Surgery. Linköping University, Faculty of Health Sciences.
    Vegfors, Magnus
    Linköping University, Department of Medicine and Care, Anaesthesiology. Östergötlands Läns Landsting, Anaesthesiology and Surgical Centre, Department of Anaesthesiology and Intensive Care VHN. Linköping University, Faculty of Health Sciences.
    Lindberg, Lars-Göran
    Linköping University, Department of Biomedical Engineering, Physiological Measurements. Linköping University, The Institute of Technology.
    Non-invasive measurement of systolic blood pressure on the arm utilising photoplethysmography: development of the methodology2005In: Medical and Biological Engineering and Computing, ISSN 0140-0118, E-ISSN 1741-0444, Vol. 43, no 1, p. 131-135Article in journal (Refereed)
    Abstract [en]

    Photoplethysmography (PPG) can be used to measure systolic blood pressure at the brachial artery. With a specially designed probe, positioned in the most distal position beneath a pressure cuff on the upper arm, this is possible. The distance between the light source (880 nm) and the photodetector was 20 mm. A test was performed on neuro-intensive care patients by determining blood pressure from the PPG curves, and, when it was compared with systolic blood pressure obtained from inserted indwelling arterial catheters, a correlation factor of r=0.95 was achieved. The difference between blood pressure obtained using PPG and invasive blood pressure measurement was 3.9±9.1 mmHg (mean±SD), n=19. The depth to the brachial artery was 13.9±4.1 mm (mean±SD), n=18. A digital PPG system utilising pulsating light was also developed.

  • 26.
    Laurent, Claes
    et al.
    Linköping University, The Institute of Technology. Linköping University, Department of Biomedical Engineering, Physiological Measurements.
    Jönsson, Björn
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Vascular surgery. Östergötlands Läns Landsting, Heart Centre, Department of Thoracic and Vascular Surgery.
    Vegfors, Magnus
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Anaesthesiology. Östergötlands Läns Landsting, Anaesthesiology and Surgical Centre, Department of Anaesthesiology and Intensive Care VHN.
    Lindberg, Lars-Göran
    Linköping University, The Institute of Technology. Linköping University, Department of Biomedical Engineering, Physiological Measurements.
    Non-invasive monitoring of systolic blood preassure on arm utilizing photoplethysmography (PPG)2000In: World Congress of Medical Physics and Biomedical Engineering,2000, Springer-Verlag , 2000, p. 131-135Conference paper (Refereed)
    Abstract [en]

    Photoplethysmography (PPG) can be used to measure systolic blood pressure at the brachial artery. With a specially designed probe, positioned in the most distal position beneath a pressure cuff on the upper arm, this is possible. The distance between the light source (880 nm) and the photodetector was 20 mm. A test was performed on neuro-intensive care patients by determining blood pressure from the PPG curves, and, when it was compared with systolic blood pressure obtained from inserted indwelling arterial catheters, a correlation factor of r=0.95 was achieved. The difference between blood pressure obtained using PPG and invasive blood pressure measurement was 3.9±9.1 mmHg (mean±SD), n=19. The depth to the brachial artery was 13.9±4.1 mm (mean±SD), n=18. A digital PPG system utilising pulsating light was also developed.

  • 27.
    Lindenberger, Marcus
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Vascular surgery.
    Olsen, H
    Länne, Toste
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Clinical Physiology. Östergötlands Läns Landsting, Heart Centre, Department of Thoracic and Vascular Surgery.
    Increased susceptibility to acute hypovolemia in ageing females2004In: Svenska Läkaresällskapets Riksstämma,2004, 2004Conference paper (Other academic)
  • 28.
    Lindenberger, Marcus
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Vascular surgery.
    Olsen, H
    Länne, Toste
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Clinical Physiology. Östergötlands Läns Landsting, Heart Centre, Department of Thoracic and Vascular Surgery.
    Indications of increased susceptibility to hypovolemic circulatory stress in ageing females2004In: 14th meeting of Hypertension,2004, 2004Conference paper (Other academic)
  • 29.
    Liss, Per-Erik
    et al.
    Linköping University, Faculty of Arts and Sciences. Linköping University, Department of Department of Health and Society, Tema Health and Society.
    Lundgren, Fredrik
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Vascular surgery. Östergötlands Läns Landsting, Heart Centre, Department of Thoracic and Vascular Surgery.
    Ethical reasons motivate screening for abdominal aortic aneurysm in 65-year-old men. Aneurytsm-related mortality can be halved.2005In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 102 32-33, p. 2216-2219Article in journal (Other academic)
  • 30.
    Lundgren, Fredrik
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Vascular surgery. Östergötlands Läns Landsting, Heart Centre, Department of Thoracic and Vascular Surgery.
    Callander, Margarita
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Neuroscience and Locomotion. Östergötlands Läns Landsting, Local Health Care Services in Central Östergötland, Department of Neurology.
    Forssell, Claes
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Vascular surgery. Östergötlands Läns Landsting, Heart Centre, Department of Thoracic and Vascular Surgery.
    Rydén, Bengt-Olof
    Stahre, Bengt-Olof
    Teoretisk modell för utveckling av AAA-operationer och ruturdöd efter införande av 65-årsscreening för män2002In: Svensk kirurgi,2002, 2002, p. 160-160Conference paper (Refereed)
  • 31.
    Länne, Toste
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Vascular surgery.
    Amerikastipendium för kirurger.2001In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 98, p. 2074-2074Article in journal (Other (popular science, discussion, etc.))
  • 32.
    Länne, Toste
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Vascular surgery. Östergötlands Läns Landsting, Heart Centre, Department of Thoracic and Vascular Surgery.
    Diagnostics of vessel disease in clinical physiology. Methods in circulatory research.2002In: Measurements of the mechanical properties of arteries, Linköping: Linköpings universitet , 2002, p. 376-389Chapter in book (Other academic)
  • 33.
    Länne, Toste
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Vascular surgery. Östergötlands Läns Landsting, Heart Centre, Department of Thoracic and Vascular Surgery.
    Measurements of the mechanical properties of arteries. (In swedish)2002In: Diagnostics of vessel disease in clinical physiology (Rosfors S, Jogestrand T), Linköping: Linköpings universitet , 2002, p. 376-389Chapter in book (Other academic)
  • 34. Olsen, H
    et al.
    Länne, Toste
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Vascular surgery. Östergötlands Läns Landsting, Heart Centre, Department of Thoracic and Vascular Surgery.
    Reduced capillary hydraulic conductivity in skeletal muscle and skin in Type 1 diabetes: a possible cause for reduced transcapillary fluid absorption during hypovolaemia.2000In: Diabetologia, ISSN 0012-186X, E-ISSN 1432-0428, Vol. 43, p. 1178-1184Article in journal (Refereed)
  • 35.
    Olsen, Henrik
    et al.
    Endokrin klin Malmö.
    Vernersson, Einar
    Anestesi klin Malmö.
    Länne, Toste
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Vascular surgery.
    Cardiovascular response to acute hypovolemia in relation to age. Implications for orthostasis and hemorrhage2000In: American Journal of Physiology. Heart and Circulatory Physiology, ISSN 0363-6135, E-ISSN 1522-1539, Vol. 278, p. 222-232Article in journal (Refereed)
  • 36.
    Rutberg, Hans
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Anaesthesiology. Östergötlands Läns Landsting, Heart Centre, Department of Thoracic and Vascular Surgery.
    Sommer, AnnSofie
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Pulmonary Medicine. Östergötlands Läns Landsting, Centre of Surgery and Oncology, Department of Respiratory Medicine UHL.
    Skau, Tommy
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Vascular surgery. Östergötlands Läns Landsting, Heart Centre, Department of Thoracic and Vascular Surgery.
    Kvalitet inom sjukvården. Vad är det och hur mäts den?2001In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 98, p. 3044-3045Article in journal (Other (popular science, discussion, etc.))
  • 37. Rydén Ahlgren, Å
    et al.
    Sundkvist, G
    Sandgren, T
    Länne, Toste
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Vascular surgery. Östergötlands Läns Landsting, Heart Centre, Department of Thoracic and Vascular Surgery.
    Female gender increases stiffness of elastic but not of muscular arteries in type I diabetic patients2002In: Clinical Physiology and Functional Imaging, ISSN 1475-0961, E-ISSN 1475-097X, Vol. 22, no 6, p. 409-415Article in journal (Refereed)
    Abstract [en]

    The reason for the particularly increased risk for cardiovascular complications in diabetic women is still unclear. We have previously found decreased distensibility of elastic arteries in type I diabetic women, indicating increased cardiac load, not seen in type I diabetic men, which might be one contributing factor. Whether the effect of gender is different in muscular arteries in type I diabetic patients has not been assessed. As estimates of arterial distensibility we measured stiffness (▀) and pressure strain elastic modulus (Ep) in the muscular common femoral artery using echotracking sonography in 30 women (mean age 34 years, range 20-61) and 26 men (mean age 38 years, range 22-56) with type I diabetes. The results were compared with those of 89 healthy individuals of corresponding age and gender and with previously published results from elastic arteries in these patients obtained at the same occasion. The internal common femoral diameter was significantly decreased in both diabetic men and women. In sharp contrast to the highly significant decreased distensibility of the elastic abdominal aorta and common carotid artery in the type I diabetic women, the distensibility of the common femoral artery did not clearly differ between patients and controls, neither for women nor for men. Thus, the gender difference in changes of arterial distensibility found in elastic arteries was absent or far less obvious in the femoral artery. In conclusion, female gender seems to affect the mechanical properties of elastic, but not of large muscular arteries in type I diabetic patients. Thus, putative gender differences in arterial changes in type I diabetes are to be sought in elastic rather than muscular arteries.

  • 38. Rydén Ahlgren, Åsa
    et al.
    Åstrand, Håkan
    Sandgren, Thomas
    Vernersson, Einar
    Sonesson, Björn
    Länne, Toste
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Vascular surgery. Östergötlands Läns Landsting, Heart Centre, Department of Thoracic and Vascular Surgery.
    Dynamic behaviour of the common femoral artery: Age and gender of minor importance2001In: Ultrasound in Medicine and Biology, ISSN 0301-5629, E-ISSN 1879-291X, Vol. 27, no 2, p. 181-188Article in journal (Refereed)
    Abstract [en]

    The distensibility of elastic arteries has been extensively studied, while studies of muscular arteries are sparse. The influences of age and gender on the mechanical properties of the common femoral artery (CFA) were studied. The pulsatile diameter changes of the CFA were noninvasively measured using echo-tracking sonography in 173 healthy volunteers (95 females, 78 males, range 7-81 years). In combination with blood pressure measurements, stiffness (▀) and pressure strain elastic modulus (Ep) were calculated. Neither ▀ nor Ep was related to age or gender and a considerable interindividual variation was present. The CFA diameter increased with age. In conclusion, the distensibility of this muscular artery is not clearly affected by age or gender, although the diameter increases with age. This indicates remodelling of the arterial wall and an impact of vascular smooth muscles on long-term wall mechanics. Thus, there appear to be fundamental differences in the dynamic behaviour of the common femoral artery when compared to elastic arteries, such as the aorta and the common carotid artery. (E-mail:asa.ryden-ahlgren@klinfys.mas.lu.se) Copyright

  • 39.
    Skau, T.
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Vascular surgery. Östergötlands Läns Landsting, Heart Centre, Department of Thoracic and Vascular Surgery.
    Hillman, Jan
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Neuroscience and Locomotion, Neurosurgery. Östergötlands Läns Landsting, Reconstruction Centre, Department of Neurosurgery UHL.
    Harder, Henrik
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Neuroscience and Locomotion, Oto-Rhiono-Laryngology and Head & Neck Surgery. Östergötlands Läns Landsting, RC - Rekonstruktionscentrum, ÖNH - Öron- Näsa- Halskliniken.
    Magnusson, Bengt
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Neuroscience and Locomotion, Oto-Rhiono-Laryngology and Head & Neck Surgery. Östergötlands Läns Landsting, RC - Rekonstruktionscentrum, ÖNH - Öron- Näsa- Halskliniken.
    Surgical treatment of distal, extracranial, internal carotid artery aneurysms involving the base of the skull - A multidisciplinary approach2000In: European Journal of Vascular and Endovascular Surgery, ISSN 1078-5884, E-ISSN 1532-2165, Vol. 20, no 3, p. 308-311Article in journal (Refereed)
    Abstract [en]

    [No abstract available]

  • 40.
    Skau, Tommy
    et al.
    Linköping University, Department of Medicine and Care, Vascular surgery. Linköping University, Faculty of Health Sciences.
    Jönsson, Björn
    Linköping University, Department of Medicine and Care, Vascular surgery. Linköping University, Faculty of Health Sciences.
    Prevalence of symptomatic leg ischaemia in a swedish community: an epidemiological study1993In: European Journal of Vascular Surgery (United Kingdom), ISSN 0950-821X, Vol. 7, no 4, p. 432-437Article in journal (Refereed)
    Abstract [en]

    The prevalence of symptomatic leg ischaemia (SLI) was studied using a standardised postal questionnaire and by measuring ankle systolic blood pressure among those with leg pain. All individuals, aged 50–89 years, of both sexes (n = 2748) in a community of 7524 inhabitants were included. The overall questionnaire response rate was 92%, of whom 441 (17%) reported any form of leg pain. Ankle systolic blood pressure (ASBP) was measured in 353 (80%) of those. Ankle/brachial index (ABI) ⩽0.8 was chosen as the criterion for verified SLI. One hundred and seven (30%) had a verified SLI (ABI ⩽0.8).Hospital records could be reviewed in 83% of the non-responders, and revealed corresponding distributions of risk factors among the non-responders and the questionnaire-responders. Risk factor frequencies among ASBP-examined and not examined individuals were also comparable. The overall prevalence of SLI in the age 50–89 years was 4.1%, ranging from 1.5% in the age decade of 50–59 years, to maximum 7.1% in the decade 70–79 years. A slight but not significant male predominance was recorded, except for the age decade 70–79 years. The prevalence of SLI in the whole community population was approximately 2000/100 000 of which 5% were possible candidates for vascular intervention.

  • 41. Svartholm, Erik
    et al.
    Annerhag, Veronica
    Länne, Toste
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Vascular surgery. Östergötlands Läns Landsting, Heart Centre, Department of Thoracic and Vascular Surgery.
    Treatment of bleeding in severe necrotizing pancreatitis with recombinant Factor vlla2002In: Anesthesiology, ISSN 0003-3022, E-ISSN 1528-1175, Vol. 96, p. 1528-1528Article in journal (Refereed)
  • 42.
    Svartholm, Erik
    et al.
    Jönköping.
    Annerhagen, Veronica
    Jönköping.
    Länne, Toste
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Vascular surgery. Östergötlands Läns Landsting, Heart Centre, Department of Thoracic and Vascular Surgery.
    Letter in reply: Use of recombinant activated factor VII in patients with severe coagulopathy and bleeding.2003In: Anesthesiology, ISSN 0003-3022, E-ISSN 1528-1175, Vol. 98, p. 1027-1027Article in journal (Refereed)
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