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K Ylönen

Publications and source records attributed to K Ylönen.

At least 19 recordsLinked to original sources
PubMed2006

Lower limb ischemic complications after the use of arterial puncture closure devices.

We report three cases of lower limb ischemia occurring after the use of arterial puncture closure devices (APCDs). In two patients, who have undergone percutaneous angioplasty of lower limb arteries, the Angio-Seal APCD led to thrombosis of the common femoral artery. In another patient who has undergone coronary angiography, this device has led to dissection of the common femoral artery. Since these observations seem to not be merely sporadic, radiologists and cardiologists as well as vascular surgeons should be aware of their possible occurrence in order to avoid these complications and to provide promptly an adequate treatment.

Aged, 80 and over↗
PubMed2005

Baseline oxygen delivery is associated with an increased risk of severe postoperative complications after elective open repair of abdominal aortic aneurysm.

AIM: Oxyhemodynamic parameters have been shown to have a relevant impact on the immediate postoperative outcome after major surgery, but it is not known their specific impact on the outcome after elective repair of abdominal aortic aneurysm (AAA). METHODS: One-hundred and forty-one patients underwent elective open repair of infrarenal AAA and hemodynamic parameters were monitored perioperatively. RESULTS: One patient (0.7%) died postoperatively, 23 (16.3%) experienced a myocardial ischemic event and 9 of them (6.4%) had a myocardial infarction. Baseline oxygen delivery was not predictive of such myocardial ischemic events. Thirty-three patients (23.4%) suffered severe postoperative complications. The median baseline oxygen delivery was 429.5 mL/min/m2 among patients who had severe postoperative complications, whereas it was 505.5 mL/min/m2 among those who did not have severe complications (p=0.03). However, this parameter did not retain its significance at multivariate analysis. When only the preoperative variables were included in the logistic regression model, the Glasgow Aneurysm Score (P=0.004, Oddsratio 1.94, 95% C.I. 1.24-3.05) was the only predictor of severe postoperative complications. The Glasgow Aneurysm Score was significantly correlated with baseline oxygen delivery (P=-0.256, P=0.003). CONCLUSIONS: Baseline oxygen delivery is associated with an increased risk of severe postoperative complications after elective open repair of AAA. The value of preoperative optimization of oxygen delivery should be evaluated in this patient population.

Aged↗
PubMed2004

Glasgow Aneurysm Score as a predictor of immediate outcome after surgery for ruptured abdominal aortic aneurysm.

BACKGROUND: The aim of the study was to assess the value of the Glasgow Aneurysm Score in predicting postoperative death after repair of a ruptured abdominal aortic aneurysm (AAA). METHODS: Between 1991 and 1999, 836 patients underwent surgery for ruptured AAA. Their operative risk at presentation was evaluated retrospectively using the Glasgow Aneurysm Score, based on data from the nationwide Finnvasc registry. RESULTS: The operative mortality rate was 47.2 per cent (395 of 836); 164 patients (19.6 per cent) had cardiac complications and 164 (19.6 per cent) required intensive care treatment for more than 5 days. Predictors of postoperative death in univariate analysis were: coronary artery disease (P = 0.005), preoperative shock (P < 0.001), age (P < 0.001), and the Glasgow Aneurysm Score (P < 0.001). In multivariate analysis the predictors were: preoperative shock (odds ratio (OR) 2.13 (95 per cent confidence interval (c.i.) 1.45 to 3.11); P < 0.001) and the Glasgow Aneurysm Score (for an increase of ten units: OR 1.81 (95 per cent c.i. 1.54 to 2.12); P < 0.001). Receiver-operator characteristic (ROC) curves showed that the best cut-off value of the Glasgow Aneurysm Score in predicting postoperative death was 84 (area under the curve 0.75 (95 per cent c.i. 0.72 to 0.78), standard error 0.17; P < 0.001). The operative mortality rate was 28.2 per cent (114 of 404) in patients with a Glasgow Aneurysm Score of 84 or less, compared with 65.0 per cent (281 of 432) in those with a score greater than 84 (P < 0.001). CONCLUSION: The Glasgow Aneurysm Score predicted postoperative death after repair of ruptured AAA in this series.

Aged↗
PubMed2003

Value of the Glasgow Aneurysm Score in predicting the immediate and long-term outcome after elective open repair of infrarenal abdominal aortic aneurysm.

BACKGROUND: This study aimed to explore the value of the Glasgow Aneurysm Score in predicting the immediate and long-term outcome after elective open repair of abdominal aortic aneurysm (AAA). METHODS: Some 403 patients underwent elective open repair of an infrarenal AAA and were classified retrospectively according to the criteria of the Glasgow Aneurysm Score (risk score = (age in years) + (7 for myocardial disease) + (10 for cerebrovascular disease) + (14 for renal disease)). RESULTS: Fourteen patients (3.5 per cent) died after operation, 23 (5.7 per cent) had a myocardial infarction and six (1.5 per cent) had a stroke. One hundred and nine patients (27.0 per cent) experienced severe postoperative complications. The Glasgow Aneurysm Score was predictive of postoperative death (area under the receiver-operator characteristic curve (AUC) 0.80, 95 per cent confidence interval (c.i.) 0.71 to 0.90), severe postoperative complications (AUC 0.67, 95 per cent c.i. 0.61 to 0.73), myocardial infarction (AUC 0.72, 95 per cent c.i. 0.62 to 0.82), myocardial infarction-related postoperative death (AUC 0.78, 95 per cent c.i. 0.63 to 0.94) and stroke (AUC 0.84, 95 per cent c.i. 0.74 to 0.95). Univariate analysis showed that this risk index was also predictive of long-term survival. CONCLUSION: The Glasgow Aneurysm Score is a good predictor of outcome after elective open repair of AAA. Its simplicity and accuracy make it useful for preoperative risk stratification.

Aged↗
PubMed2002

Endovascular treatment of aortic aneurysms in Finland: the first four years' experience.

BACKGROUND AND AIMS: In this study the results of endovascular treatment of aortic aneurysms in Finland are presented and compared to the results of the Eurostar registry. MATERIAL AND METHODS: A total of 229 patients with aortic aneurysm were treated in five different Finnish centres during 1996-2000. The data of these patients were collected prospectively by surgeon or interventional radiologist involved. During the same period of time 2464 patients were registered in the Eurostar registry. RESULTS: The procedure was performed successfully in 97% of patients in Finland, and the 30-day mortality was 0,9%. A graft limb thrombosis was detected in 9% of the patients in Finland. A permanent primary endoleak at the first 30-day control was seen in 23 patients (10%). During the follow-up 17 secondary endoleaks (7%) were detected. A secondary intervention was necessary in 26% of the patients. Three patients (1.3%) had late rupture of the abdominal aortic aneurysm. CONCLUSIONS: According to the Finnish short-time results, endovascular treatment of aortic aneurysms is safe and associated with relatively low morbidity and mortality. The mid-term results are more disappointing with relatively many graft thromboses and endoleaks, and a frequent need of secondary interventions.

Adult↗
PubMed2001

Endovascular surgery for chronic limb ischaemia. Factors predicting immediate outcome on the basis of a nationwide vascular registry.

PURPOSE: To evaluate the early results of endovascular treatment of chronic limb ischemia and the factors influencing outcome. METHODS: The 5,575 endovascular procedures entered into the national vascular registry in 1991-1994 were reviewed retrospectively. Indication was claudication in 3,873 and chronic critical ischemia (CLI) in 1,702 procedures. In CLI most patients were women and older, with a higher proportion of diabetes mellitus, renal insufficiency and coronary heart disease than in claudication group although the incidence of smoking and hyperlipidaemia was lower. 60.2% of the procedures were performed in femoropopliteal arteries, 24.9% in iliac arteries and 14.9% in infrapopliteal arteries. The follow-up was 30 days. RESULTS: In the claudication group there was clinical improvement in 2,719 (82.8%) and in the CLI group in 851 (70.9%) of patients. Patency was better in the claudication than in CLI group, 94.6% vs. 89.0% respectively. There was hemodynamic improvement, i.e. improvement of the ankle-brachial index of more than 0.15 in 1,680 (58.2%) patients with claudication and in 437 (59.7%) with CLI. In a logistic regression model diabetes mellitus and renal insufficiency increased the relative risk of amputations and mortality in CLI group, whereas, incidence of amputations was lower in patients with hyperlipidaemia. In claudication group femoropopliteal arteries had an adverse effect on patency. CONCLUSION: The clinical characteristics of the groups may explain some of the outcome differences. Angioplasty is recommended to be used in the femoropopliteal arteries if the symptoms are severe and in CLI group with diabetes and renal failure only in selected cases.

Adult↗
PubMed2000

Two year prospective dietary survey of newly diagnosed children with diabetes aged less than 6 years.

The food consumption of 38 children newly diagnosed with diabetes aged < 6 years at diagnosis was assessed by 5 day food records. During the 2 year follow up, the proportion of the total energy intake made up of protein decreased from 20% to 18%, that of carbohydrates from 54% to 52%, and that of fat increased from 26% to 30%. The energy intake from sucrose (3%) did not change. In addition, There was a small decrease in the intake of fibre and several vitamins and minerals. One year after diagnosis, the diet of diabetic children was compared with that of 66 age, sex, and social status matched control children. More energy was derived from protein (19% v 15%) and carbohydrates (53% v 50%), and less from fat (28% v 35%), especially from saturated fatty acids (11% v 15%), and sucrose (3% v 16%) in the diet of children with diabetes compared with that of control children. The higher intakes of several vitamins and minerals reflected the higher nutrient density of the diet of children with diabetes. Therefore, the diet of young children with diabetes met the dietary recommendations for subjects with diabetes. Only the protein content of the diet was higher than necessary.

Child, Preschool↗
PubMed2000

Weekly and seasonal variation of hospital admissions and outcome in patients with acute lower limb ischaemia treated by surgical and endovascular means.

BACKGROUND: The aim of this study was to investigate weekly and seasonal variation of hospital admissions, major amputations and mortality in patients treated for acute leg ischaemia by surgical and endovascular procedures. METHODS EXPERIMENTAL DESIGN: Retrospective study. SETTING: University (5), central (16) and district (4) hospitals participating in the Finnish national vascular registry Finnvasc. PATIENTS: 1550 patients treated for acute leg ischaemia on the basis of the registry. INTERVENTIONS: Surgical or endovascular revascularisation. MEASURES: Day of the week of hospital admission, major amputation and death. RESULTS: The weekly pattern of the hospital admissions was significantly non-uniform with a Monday peak and a weekend nadir. A tendency towards more hospital admissions in the winter season was found. PATIENTS hospitalised on Thursday or Friday tended to have a lower amputation rate compared to those hospitalised in any other day of week. The highest amputation and mortality rates were observed in the summer season. CONCLUSIONS: PATIENTS with acute leg ischaemia seek medical help in a non-uniform weekly and seasonal pattern with varying outcomes.

Acute Disease↗
PubMed1999

Mortality in ruptured abdominal aortic aneurysms. The Finnvasc Study Group.

OBJECTIVE: To assess mortality related to rupture of abdominal aortic aneurysm (RAAA). DESIGN: A 4-year cross-sectional study based on a nationwide vascular registry Finnvasc and national cause-of-death registry (Statistics Finland). MATERIALS AND METHODS: A total of 454 operations for RAAA among 11,747 surgical vascular reconstructions recorded in the Finnvasc registry and 1004 deaths due to RAAA during the same period based on Statistics Finland. RESULTS: The operative mortality rate was 49% based on the Finnvasc registry and 54% based on Statistics Finland. With all RAAA deaths at hospitals included, total hospital mortality was 68%. No association existed between hospital volume of RAAA operations and surgical mortality, although an inverse association did exist between hospital volume of RAAA operations and all RAAA deaths in the hospital (p = 0.01). The case fatality for RAAA in Finland was 80%. CONCLUSIONS: RAAA surgical mortality calculations for RAAA, based on a vascular registry, underestimate the true rate because some cases with fatal outcome tend to escape registration. Because surgical mortality rates may also be skewed by patient selection, total hospital RAAA mortality thus represents the results of RAAA treatment more accurately.

Aortic Aneurysm, Abdominal↗
PubMed1999

Self-determination in nursing students: an empirical investigation.

The purpose of this descriptive study was to examine nursing students' perceptions of student self-determination in a Finnish health-care institute and to find out whether background data were in any way associated with these perceptions. To do this we developed a 56-item Students Self-Determination Questionnaire (SSDQ), which was completed by 435 nursing students. The results showed that self-determination is important for nursing students and that they are willing to exercise self-determination in their training. In practice, however, the students were not very active in this respect, nor did they feel that they were getting very much support from teaching staff. The meaning of self-determination increased with age and with increasing experience.

Adolescent↗
PubMed1998

Factors affecting the results of surgery for chronic critical leg ischemia--a nationwide survey. Finnvasc Study Group.

PURPOSE: To assess the factors affecting immediate outcome of surgery for chronic critical leg ischemia, especially the influence of surgeon's caseload and hospital volume. METHODS: The data of Finnvasc registry were retrospectively analyzed. A total of 11,747 surgical vascular reconstructions included 1,761 operations for chronic critical leg ischemia during 1991 to 1994. RESULTS: The 30-day postoperative leg amputation rate was 7.5% and the mortality rate 4.7%. Diabetes, previous vascular surgery or amputation, preoperative ulcer or gangrene, a surgeon's annual caseload fewer than 10 operations, and hospital volume fewer than 20 operations for chronic critical leg ischemia adversely affected amputation rates. The presence of coronary artery disease and renal dysfunction increased postoperative mortality rates. Both amputation rates and postoperative mortality rates were affected by the type of procedure. CONCLUSIONS: A surgeon's caseload and hospital volume affect amputation rate, but not mortality rate, in patients operated for chronic critical leg ischemia.

Aged↗
PubMed1998

Influence of surgical experience on the results of carotid surgery. The Finnvasc Study Group.

OBJECTIVE: To assess the 30-day mortality and morbidity rates related to carotid endarterectomy on a nation-wide basis. DESIGN: Retrospective cross-sectional study based on vascular registry Finnvasc. MATERIALS AND METHODS: A total of 17,465 recorded vascular and endovascular procedures included exactly 1600 carotid endarterectomies performed by 104 surgeons in 23 hospitals. Fourteen per cent of the patients were operated on for asymptomatic carotid stenosis. RESULTS: The combined mortality and permanent stroke rate was 3.3%, without any difference between operations done on symptomatic or asymptomatic patients. There was a clear inverse association between surgeon's carotid case load and poor outcomes in carotid surgery (p < 0.005), the critical patient mass per surgeon and year being 10 operations. There was no association between outcome after carotid surgery and hospital volume of carotid operations. CONCLUSIONS: Surgeon's experience in carotid surgery clearly improves the results of carotid surgery.

Carotid Arteries↗
PubMed1998

Do vascular registers affect decision-making? Finnvasc Study Group.

Treatment activity of vascular diseases varies depending on population, preference of doctors and the availability of vascular surgical services. Vascular registry offers an opportunity to review practice, to compare outcome with a standard, and to implement change to improve practice. Prospective data collection of all reconstructive vascular procedures has been performed in Finland for seven years. According to a review of the first five years, combined vascular and endovascular activity has increased nation-wide from 3508 procedures done in 1991 to 5200 in 1995. There are marked regional differences in the frequency and selection of various treatment modalities, which can not be explained only by epidemiological data but as well by skewed vascular care delivery. This data can be used for decision-making and should be used for planning of the vascular surgical services in Finland.

Data Collection↗
PubMed1997

Auditing a nationwide vascular registry--the 4-year Finnvasc experience. Finnvasc Study Group.

OBJECTIVE: To assess the validity of a national vascular registry. MATERIALS AND METHODS: 17,465 vascular and endovascular procedures, immediate reoperations excluded, registered in the Finnvasc registry from 26 centres during the years 1991-1994. CHIEF OUTCOME MEASURES: Comparison of the number of registered procedures with hospital records, comparison of initial registrations with a random sample of re-registration and comparison of the 1-year local data input of one major centre to the same data input of the central unit. RESULTS: The rate of missing registrations was 19% ranging from 0-47%. The data of the re-registered forms were in agreement with the original data in 93% of all data points, the range being from 81-100%. There was a difference of 1.5% in the data between the major centre and the central unit. CONCLUSIONS: The Finnvasc registry makes it possible to audit vascular surgery nationally, although a potential limitation is centres with low registration rates.

Finland↗
PubMed1997

Mortality in abdominal aortic aneurysm surgery--the effect of hospital volume, patient mix and surgeon's case load.

OBJECTIVE: Assessment of mortality in abdominal aortic aneurysm surgery. DESIGN: A 4-year cross sectional study based on a nationwide vascular registry: Finnvasc. MATERIAL AND METHODS: A total of 17,465 vascular interventions included 929 elective repairs for abdominal aortic aneurysms (AAA), and 610 emergency cases with 454 ruptures. Fifty-three percent of the operations were done in university hospitals, 44% in central hospitals and 3% in district hospitals. RESULTS: The 30-day mortality rate for AAA repair was 5.1% in elective and 46% in ruptured cases. A clear dependence of operative mortality on surgeon's experience in AAA surgery was observed, both regarding the surgeon's total vascular case load (p < 0.01) and the number of operated elective aneurysms (p < 0.01), but not the number of operated ruptured aneurysms. However, no association was found between hospital volume and mortality in AAA surgery. CONCLUSIONS: Vascular surgical experience clearly improves the results of elective aneurysm surgery.

Aneurysm, Ruptured↗
PubMed1996

Frequency of repeated vascular surgery. A survey of 7616 surgical and endovascular Finnvasc procedures. Finnvasc Study Group.

OBJECTIVE: To assess the incidence of repeated vascular surgical operations. DESIGN: A population-based cross-sectional survey established on the Finnvasc registry. SETTING: Multicentre, Finland. MATERIAL: 7616 vascular procedures consisted of 5201 open vascular operations and 2415 endovascular interventions done during the two years 1991-92. MAIN OUTCOME MEASURES: Mortality and number of reoperations and major amputations. RESULTS: A total of 5409 initial vascular procedures were done, 770 patients (10%) underwent a new procedure in the same anatomical segment as previously, and 1437 patients (19%) underwent a vascular or endovascular procedure on a new arterial segment excluding the coronary arteries; these patients had more risk factors than the two other groups, and were also treated more often for chronic leg ischaemia. Altogether 586 reoperations were needed in 487 patients (6%) during a 30-day postoperative period, more often after the initial surgical reconstruction than on other occasions. Altogether 126 postoperative below-knee and 170 above-knee amputations had to be done during the same period which corresponded to 14% of the total of 2128 surgical or endovascular revascularisations done for acute or chronic critical leg ischaemia. The risk of perioperative death was higher in patients with acute leg ischaemia undergoing their first vascular intervention than those having repeat operations. CONCLUSION: Although the present data are cross-sectional and might be affected by the recent increase in vascular surgery in Finland they show that almost a third of vascular operations done are repeat procedures.

Aged↗