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Martin Björck

Publications and source records attributed to Martin Björck.

At least 19 recordsLinked to original sources
PubMed2007

Iatrogenic vascular injuries in varicose vein surgery: a systematic review.

BACKGROUND: Iatrogenic vascular injuries during varicose vein surgery are serious. The aim of this study was to investigate their nature and consequences. METHOD: A systematic literature research was performed. RESULTS: The incidence is low (0.0017%-0.3%). We found 81 patients suffering from 87 vascular injuries-44 arterial and 43 deep vein injuries. CONCLUSION: Vascular injuries during varicose surgery are rare but serious. They are avoidable, and when they occur, early recognition is crucial. Bleeding is a common symptom, especially in deep venous injury. In our study, we reviewed the literature on 81 patients with 87 vascular injuries. Laceration or division of the femoral vein dominated venous injuries (28/43). Partial stripping of the femoral vein was not common (4/43) and occurred when the strip probe passed into the deep veins through a perforator. Arterial stripping predominated in arterial injuries (17/44) and happened when stripping distally during a primary operation, as reported by experienced surgeons, in nonobese women. Major arterial complications resulted in ischemia, often with diagnostic delay and poor reconstruction results. Only 30% (13/44) of arterial injuries were detected peroperatively. The amputation rate was 34% (15/44), but rose to 100% if combined with intra-arterial sclerotherapy (5/5 cases). When stripping an artery below the femoral artery, the amputation rate was high (42%; 5/12) and morbidity severe (85%; 11/12). All fatal injuries (5 cases) were venous. Anatomic knowledge and awareness of the possibility of vascular complications should be preventive. Early detection by routine checking of arterial circulation is important.

Femoral Artery↗
PubMed2006

Long-term survival after carotid endarterectomy for asymptomatic stenosis.

BACKGROUND AND PURPOSE: Large randomized trials have demonstrated a net benefit of carotid endarterectomy (CEA) for asymptomatic carotid artery stenosis compared with best medical treatment. However, it takes years to overcome the perioperative risk and gain the reduction in stroke or death risk. Long-term survival after CEA for asymptomatic stenosis may be an important consideration in deciding on this prophylactic procedure, but is not well documented. The aim was to analyze long-term survival after CEA for asymptomatic stenosis and the impact of risk factors in a population-based study. METHODS: The Swedish vascular registry (Swedvasc) covers all centers performing CEA. Data on all registered CEAs during 1994 to 2003 were retrieved. All patients were cross-matched with the Population-Registry for accurate data on mortality (date of death). Analyses with Kaplan-Meier curves for survival and relative odds ratio (OR) for predictors of survival were performed. RESULTS: A total of 6169 CEAs in 5808 patients were registered, with a median time at risk of 5.1 (range, 0.1 to 11.8) years. The indication for CEA was asymptomatic stenosis in 10.8% of the patients. Survival after CEA for asymptomatic stenosis was 78.2% after 5 and 45.5% after 10 years. Previous vascular surgery (OR, 1.8; 1.1 to 3.0), cardiac disease (OR, 1.7; 1.0 to 2.8), diabetes mellitus (OR, 2.3; 1.3 to 4.1), and age (OR, 1.5; 1.1 to 2.1 per 10 years) were predictors of decreased 5-year survival. CONCLUSIONS: In this population-based study of patients operated on for asymptomatic stenosis, a substantial reduction in long-term survival was observed. Predictors of decreased longevity were age at operation, diabetes, cardiac disease, and previous vascular surgery.

Aged↗
PubMed2006

Outcomes of carotid endarterectomy for asymptomatic stenosis in Sweden are improving: Results from a population-based registry.

OBJECTIVE: In large randomized trials, carotid endarterectomy (CEA) for asymptomatic stenosis has shown a net benefit compared with best medical treatment. To justify an increased number of procedures for this indication, the perioperative risk of stroke or death must not exceed that of the trials. The aim of this study was to evaluate the outcome in routine clinical practice in Sweden in a population-based study. METHODS: The Swedish Vascular Registry (Swedvasc) covers all centers performing CEA. Data on all registered CEAs during 1994 to 2003 were analyzed both for the whole time period and for two 5-year periods to study alterations over time. Four validation procedures of the registry were performed. Medical records were reviewed for both a random sample and a target sample (a total of 12% of the CEAs for asymptomatic stenosis). Swedvasc data were cross-matched with the In-Patient-Registry (used for reimbursement) and the Population-registry (death). RESULTS: A total of 6182 CEAs were registered, 671 being for asymptomatic stenosis. In the validation process, no missed registration of major stroke or death was found. Patients with asymptomatic stenosis had, when the whole time-period was analyzed, a perioperative combined stroke or death rate of 2.1%. Outcome improved over time; the combined stroke or death rate decreased from 3.3% (11/330) from 1994 to 1998 to 0.9% (3/341) from 1999 to 2003 (P = .026). During the second time period, no patient with a perioperative major stroke or death was reported. CONCLUSIONS: This extensively validated national audit of CEA for patients with asymptomatic carotid artery stenosis showed results well comparable with those of the randomized trials. The results improved over time.

Aged↗
PubMed2006

Portal vein thrombosis: prevalence, patient characteristics and lifetime risk: a population study based on 23,796 consecutive autopsies.

AIM: To assess the lifetime cumulative incidence of portal venous thrombosis (PVT) in the general population. METHODS: Between 1970 and 1982, 23,796 autopsies, representing 84% of all in-hospital deaths in the Malmö city population, were performed, using a standardised protocol including examination of the portal vein. PVT patients were characterised and the PVT prevalence at autopsy, an expression of life-time cumulative incidence, assessed in high-risk disease categories and expressed in terms of odds ratios and 95% CI. RESULTS: The population prevalence of PVT was 1.0%. Of the 254 patients with PVT 28% had cirrhosis, 23% primary and 44% secondary hepatobiliary malignancy, 10% major abdominal infectious or inflammatory disease and 3% had a myeloproliferative disorder. Patients with both cirrhosis and hepatic carcinoma had the highest PVT risk, OR 17.1 (95% CI 11.1-26.4). In 14% no cause was found; only a minority of them had developed portal-hypertension-related complications. CONCLUSION: In this population-based study, PVT was found to be more common than indicated by previous clinical series. The markedly excess risk in cirrhosis and hepatic carcinoma should warrant an increased awareness in these patients for whom prospective studies of directed intervention might be considered.

Adult↗
PubMed2006

Popliteal venous aneurysm--a systematic review.

BACKGROUND: Popliteal vein aneurysm is a rare but potentially problematic disease with a risk of pulmonary embolism. METHOD: A systematic literature search was performed. RESULTS: A total of 105 popliteal vein aneurysms were identified, with a slight female and left-sided preponderance. Dominating symptoms are caused by pulmonary embolism, followed by local symptoms with a palpable mass. In four patients arterial symptoms were reported. The most frequently used diagnostic test was phlebography, increasingly replaced by duplex ultrasonography in recent years. Because pulmonary embolism is a potential, it motivates surgical removal. In most cases excision and lateral suture is possible. Four fatal cases were reported. Unfortunately follow-up time and results are poorly documented. CONCLUSION: Popliteal venous aneurysm is rare but should be considered as a local source of pulmonary embolism when no other explanation is found.

Aneurysm↗
PubMed2006

Intraoperative identification of the internal carotid artery: a safety issue.

The correct intraoperative anatomic identification of the vascular structures in the carotid artery bifurcation is important, and in most operations, this is not a problem. Experiences with two cases are used to suggest a stepwise system to guarantee that anatomic confusion--a confusion that may be fatal--does not occur.

Aged↗
PubMed2006

Cost-effectiveness of screening women for abdominal aortic aneurysm.

BACKGROUND: Women are usually not considered for abdominal aortic aneurysm (AAA) screening because of their lower prevalence of disease. This position may, however, be questioned given the higher risk of rupture and the longer life expectancy among women. The purpose of this study was to assess the cost-effectiveness of screening 65-year-old women for AAA. METHODS: A systematic review of the literature was conducted to obtain data of importance to evaluate the effectiveness of screening women for AAA. Data were entered into a Markov simulation cohort model. RESULTS: The review suggested some main assumptions for women with AAA. Prevalence is 1.1%. In 6.8%, the AAA is of a size that merits surgery, and the patients are fit for a procedure. For patients with an AAA, the yearly risk for elective surgery and the rupture incidence was 3.1% and 2.4%, respectively, in the invited group and 1.1% and 5.7% in the noninvited group. The operative mortality for elective surgery was 3.5%, and the total mortality for ruptured AAA was 86.3%. The long-term mortality for AAA patients was 3.6 times higher than for an age-matched healthy population. Screening reduced the AAA rupture incidence by 33% and the AAA-related death rate by 35%. The cost per life year gained was estimated at $5911. CONCLUSION: The incremental cost-effectiveness ratio was similar to that found for screening men, which reflects the fact that the lower AAA prevalence in women is balanced by a higher rupture rate. Screening women for AAA may be cost-effective, and future evaluations on screening for AAA should include women.

Aged↗
PubMed2006

Fatal colonic ischemia: A population-based study.

OBJECTIVES: To estimate the incidence of fatal colonic ischaemia (CI) and the cause-specific mortality of CI, and to describe the localization and extension of colonic infarction and quantify the risk factors associated with CI. MATERIAL AND METHODS: Between 1970 and 1982 the autopsy rate in Malmö, Sweden, was 87%, creating the possibilities for a population-based study. Out of 23,446 clinical autopsies, 997 cases were coded for intestinal ischaemia in a database. In addition, 7569 forensic autopsy protocols were analysed. In a case-control study nested in the clinical autopsy cohort, four CI-free controls, matched for gender, age at death and year of death, were identified for each fatal CI case in order to evaluate the risk factors. RESULTS: The cause-specific mortality ratio was 1.7/1000 autopsies. The overall incidence of autopsy-verified fatal CI was 1.7/100,000 person years, increasing with age up to 23/100,000 person years in octogenarians. Fatal cardiac failure (odds ratio (OR) 5.2), fatal valvular disease (OR 4.3), previous stroke (OR 2.5) and recent surgery (OR 3.4) were risk factors for fatal CI. Narrowing/occlusion of the inferior mesenteric artery (IMA) at the aortic origin was present in 68% of the patients. The most common segments affected by transmural infarctions were the sigmoid (83%) and the descending (77%) colon. CONCLUSIONS: Heart failure, atherosclerotic occlusion/stenoses of the IMA and recent surgery were the main risk factors causing colonic hypoperfusion and infarction. Segments of transmural infarctions were observed within the left colon in 94% of the patients. Awareness of the diagnosis and its associated cardiac comorbidities might help to improve survival.

Aged↗
PubMed2006

Low frequency of phlebographic deep vein thrombosis after laparoscopic cholecystectomy--a pilot study.

To investigate the rate of deep vein thrombosis (DVT) after laparoscopic surgery, 50 patients underwent bilateral phlebography 7-11 days after laparoscopic cholecystectomy (LC). All received thromboembolism prophylaxis, either low molecular weight heparin (LMWH) or dextran. Three patients were converted to open cholecystectomy. D-dimer was investigated preoperatively, on day 1 and on the day of phlebography. One asymptomatic DVT was found. One phlebogram was incomplete. Seven phlebograms were not optimal but of sufficient quality to rule out DVT. The frequency of DVT was thus 1 of 49 or 2.0% (95% confidence interval, 0-6.0%). No anticoagulants were prescribed after discharge. No patient developed late thromboembolic complications. D-dimer values increased significantly at day 1 and were further increased at the time of phlebography. The frequency of phlebographical DVTs thus seems to be low despite prophylaxis of questionable efficacy. The D-dimer values, however, suggest that the effects of LC on coagulation/fibrinolysis have a duration of longer than 1 week.

Adult↗
PubMed2005

Mesenteric venous thrombosis with transmural intestinal infarction: a population-based study.

OBJECTIVE: To determine the cause-specific mortality from and incidence of transmural intestinal infarction caused by mesenteric venous thrombosis (MVT) in a population-based study and to evaluate the findings at autopsy by evaluating autopsies and surgical procedures. METHODS: All clinical (n = 23,446) and forensic (n = 7569) autopsies performed in the city of Malmö between 1970 and 1982 (population 264,000 to 230,000) were evaluated. The autopsy rate was 87%. The surgical procedures were performed in 1970, 1976, and 1982. Autopsy protocols coded for intestinal ischemia or mesenteric vessel occlusion, or both, were identified in a database. In all, 997 of 23,446 clinical and 9 of 7,569 forensic autopsy protocols were analyzed. A 3-year sample of the surgical procedures, comprising 21.3% (11,985 of 56,251) of all operations performed during the entire study period, was chosen to capture trends of diagnostic and surgical activity. In a nested case-control study within the clinical autopsy cohort, four MVT-free controls, matched for gender, age at death, and year of death were identified for each fatal MVT case to evaluate the clinical autopsy findings. RESULTS: Four forensic and 23 clinical autopsies demonstrated MVT with intestinal infarction. Seven patients were operated on, of whom six survived. The cause-specific mortality ratio was 0.9:1000 autopsies. The incidence was 1.8/100,000 person years. At autopsy, portal vein thrombosis and systemic venous thromboembolism occurred in 2 of 3 and 1 of 2 of the cases, respectively. Obesity was an independent risk factor for fatal MVT (P =.021). CONCLUSIONS: The estimated incidence of MVT with transmural intestinal infarction was 1.8/100,000 person years. Portal vein thrombosis, systemic venous thromboembolism and obesity were associated with fatal MVT.

Adult↗
PubMed2005

Risk factors associated with abdominal aortic aneurysm: a population-based study with historical and current data.

OBJECTIVES: To define risk factors associated with the development of abdominal aortic aneurysm (AAA) in a population-based case-control study. MATERIAL AND METHODS: Thirty-five patients found to have AAA at screening were compared with 140 age- and sex-matched controls. Three distinct comparisons were made. Current risk factors in both cohorts were compared. Because data were also available for both cohorts from a study conducted 12 years previously, a historical comparison was made between risk factors identified at the time of this initial evaluation. A longitudinal comparison was made between historical and current risk factors. RESULTS: Elevated low-density-lipoprotein cholesterol, total cholesterol, and triglyceride levels 12 years before AAA screening were associated with current AAA with an odds ratio (OR) of 2.3 (95% confidence interval [CI], 1.2 to 4.4); OR, 1.9 (95% CI, 1.3 to 2.8); and OR, 1.9 (95% CI,1.2 to 3.1)/mmol/L, respectively. Current variables assessed at AAA screening that were associated with AAA were: A history of atherosclerotic disease, OR, 3.8 (95% CI, 1.7 to 8.5); having a first-degree relative with AAA, OR, 4.4 (95% CI, 1.5 to 13.0); current smoking, OR, 5.2 (95% CI, 1.6 to 16.8); high-density-lipoprotein cholesterol level, OR, 0.1 (95% CI, 0.02 to 0.7)/mmol/L; and high-sensitivity C-reactive protein (hsCRP) level, OR, 1.1 (95% CI, 1.01 to 1.2)/mg/L. Hypertension and diabetes were not associated with AAA. A significant increase of hsCRP over time (12 years) was observed in AAA patients ( P = .039) but not among controls. The variables of a history of atherosclerosis, smoking, and family history of AAA appear to interact synergistically to increase the prevalence of AAA ( P < .001). CONCLUSION: Among traditional risk factors for atherosclerosis, some were associated with AAA and others were not, indicating complex and partly different causes. Inflammation and heredity appear to be important factors in the development of AAA.

Age Factors↗
PubMed2005

Cost-effectiveness of different screening strategies for abdominal aortic aneurysm.

OBJECTIVE: The primary objective of this study was to develop a simulation model to assess the cost-effectiveness of different screening strategies for abdominal aortic aneurysms (AAAs) in men. METHODS: A systematic review of the literature was conducted for different screening strategies in terms of age (60, 65, or 70 years) and risk profiles (all men or specific high-risk groups) of the screened population, and rescreening after 5 or 10 years. These data were analyzed in a Markov simulation cohort model. RESULTS: The cost per life year gained for different screening strategies ranged from US 8,309 dollars to US 14,084 dollars and was estimated at US 10,474 dollars when 65-year-old men were screened once. Screening 60-year-old men was equally cost-effective, with the advantage of more life years gained. We demonstrated a trade-off between high prevalence of AAA and lower life expectancy, eliminating the expected benefits of screening high-risk groups such as smokers (US 10,695 dollars) or cardiovascular patients (US 10,392 dollars). Assuming general population utility resulted in a cost per quality-adjusted life year (QALY) gained of US 13,900 dollars, whereas a hypothetical 5% reduction in utility among men with a screening-detected AAA raised the cost per QALY gained to US 75,100 dollars. CONCLUSION: This Markov model, which was based on a systematic review of the literature, supplied information on the estimated cost-effectiveness of different screening strategies. Screening men for AAA may be cost-effective in the long-term. Different screening strategies and quality-of-life effects related to screening for AAA need to be evaluated in future clinical studies.

Age Factors↗
PubMed2005

Clinical implications for the management of acute thromboembolic occlusion of the superior mesenteric artery: autopsy findings in 213 patients.

OBJECTIVE: To study findings at autopsy in patients with fatal acute thromboembolic occlusion of the superior mesenteric artery (SMA). SUMMARY BACKGROUND DATA: Acute occlusion of the SMA is difficult to diagnose and mortality remains high. In Malmo, Sweden, the autopsy rate between 1970 and 1982 was 87%, creating possibilities for a population-based study. METHODS: Among 23,496 clinical autopsies and 7569 forensic autopsies, 213 cases with acute thromboembolic occlusion of the SMA and intestinal infarction were identified. RESULTS: A clinical suspicion of intestinal infarction was documented in 32% of the patients, only 35% being in the care of surgeons. The embolus/thrombus ratio was 1.4 to 1. Thrombotic occlusions were located more proximally than embolic occlusions (P < 0.001), intestinal infarction was more extensive (P = 0.025) and thrombotic occlusions were associated with old brain infarction (P = 0.048), aortic wall thrombosis (P = 0.080), and disseminated cancer (P = 0.079). Patients with embolic occlusions (n = 122) had a higher frequency of acute myocardial infarction (AMI) than patients with thrombotic occlusions (P = 0.049). The embolic source was identified in 80%. In 115 (94%), synchronous embolism and/or source of embolus were present. There were findings of remaining cardiac thrombi in 58 (48%) and synchronous emboli affected 273 other arterial segments in 83 (68%). CONCLUSIONS: Early recognition and revascularization would have been a prerequisite for survival in at least half of the patients, since the jejunum, ileum, and colon were affected by infarction. A minority of all patients were under surgical care. AMI, cardiac thrombi, and synchronous emboli were common findings among patients with embolic occlusions.

Acute Disease↗
PubMed2004

Low quality of life prior to screening for abdominal aortic aneurysm: a possible risk factor for negative mental effects.

The objective of this study was to evaluate the effect on quality of life (QOL) of screening for abdominal aortic aneurysm (AAA) in a population-based AAA screening program. Twenty-four patients with screening-detected AAA and 45 controls with normal aortic diameter were studied in a prospective, controlled, population-based study. Prior to and 12 months after the ultrasonography examination, all participants completed Short-Form 36 and at 12 months, 10 AAA-specific questions were added. Comparisons were made between the two groups (AAA patients and controls), within each group, and between the groups and norms for the general Swedish population in the same age interval. Our results showed that screening for AAA results in impairment of QOL among those who have the disease and who suffered a low QOL prior to screening. Among those who had an age-adjusted normal QOL prior to screening and who were found to have the disease, and among those who were found to have normal aortas, no negative effect on QOL was observed. Thus, low QOL before screening is a possible risk factor for negative mental effects of diagnosing an AAA by screening.

Activities of Daily Living↗
PubMed2004

Activation of fibrinolysis and coagulation in non-occlusive intestinal ischaemia in a pig model.

The present study was carried out to explore the dynamics of the fibrinolytic and coagulation systems during non-occlusive intestinal ischaemia in a porcine model. Nineteen pigs underwent laparotomy. The inferior mesenteric artery and the collateral vessels to the rectum were ligated. The superior mesenteric artery (SMA) was isolated at its origin from the aorta, and constriction and flowmeter devices were applied. The blood flow of the SMA was reduced to cause ischaemia in the distal colon within the pHi interval 6.9-7.1. Fibrinogen, soluble fibrin, D-dimer, tissue plasminogen activator/plasminogen activator inhibitor-1 (tPA/PAI-1) complex and albumin were measured. Corrections for pig D-dimer and albumin were performed. Fibrinogen decreased significantly after laparotomy (P < 0.0001) and further after constriction of the SMA (P < 0.05), whereas soluble fibrin increased significantly (P < 0.005) after constriction of the SMA. The tPA/PAI-1 complex increased significantly after laparotomy (P < 0.05) and, after constriction of the SMA, the values first tended to decrease (P = 0.06) and then to increase (P = 0.056). The need to calibrate assays of human plasma proteins when applying them to experimental pig models was demonstrated. After constriction of the SMA, there was a rapidly reversed peak in the coagulation marker soluble fibrin and a strong tendency of alteration of the fibrinolytic marker tPA/PAI-1 complex.

Animals↗
PubMed2003

[Screening for abdominal aortic aneurysm saves lives at a reasonable cost].

Ruptured abdominal aortic aneurysms (AAA) cause 600 deaths per year in Sweden. As most patients are without symptoms prior to rupture, and about half the patients with a ruptured AAA die before arrival to hospital, the only way to reduce mortality substantially would be by screening and prophylactic treatment. The article reviews experience of screening for AAA from other European countries, data from the Swedish vascular registry (Swedvasc) and from the official registry of the causes of death in Sweden. With these data as input, a theoretical model of inviting all 65-year-old men in Sweden to take part in a screening programme for AAA is created. When the programme is fully developed after ten years, assuming an attendance rate of 75%, mortality in AAA would decrease from 630 to 346 per year. The total cost would increase from 154 to 161 million SEK (9 SEK = 1 Euro). The reason for the relatively minor increase in cost is explained by the fact that expensive emergency operations for ruptured AAA decrease by 50%. The cost per life saved would be 3,000-4,000 SEK. In conclusion, available data suggest that screening for AAA in Sweden would save many lives at a low cost.

Aortic Aneurysm, Abdominal↗