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  • 1.
    Hörer, Tal M.
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Department of Cardio-Thoracic and Vascular Surgery, Örebro University Hospital, Sweden.
    Skoog, Per
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Department of Cardio-Thoracic and Vascular Surgery, Örebro University Hospital, Sweden.
    Nilsson, Kristofer F.
    Department of Cardio-Thoracic and Vascular Surgery, Örebro University and Örebro University Hospital, Sweden.
    Oikinomakis, Ioannis
    Department of Surgery Örebro University and Örebro University Hospital, Sweden.
    Larzon, Thomas
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Department of Cardio-Thoracic and Vascular Surgery, Örebro University and Örebro University Hospital, Sweden.
    Norgren, Lars
    Örebro University, School of Health and Medical Sciences. Department of Surgery Örebro University and Örebro University Hospital, Sweden.
    Jansson, Kjell
    Department of Surgery Örebro University and Örebro University Hospital, Sweden.
    Intraperitoneal metabolic consequences of supra-celiac aortic balloon occlusion versus superior mesenteric artery occlusion: an experimental animal study utilising microdialysisManuscript (preprint) (Other academic)
    Abstract [en]

    Objective: To investigate the effect of aortic supra-celiac balloon occlusion (ABO) and superior mesenteric artery (SMA) occlusion on abdominal visceral metabolism in an animal model by using intraperitoneal microdialysis (IPM) and laser Doppler flowmetry. Design: Prospective study in pigs

    Material and methods: Nine pigs were subjected to ABO and seven animals were subjected to SMA occlusion for one hour followed by three hours of reperfusion. Seven animals served as controls. Hemodynamic data, arterial blood samples, urinary output and intestinal mucosal blood flow (IBF) were followed hourly. Intraperitoneal (i.p) glucose, glycerol, lactate and pyruvate concentrations and lactate-pyruvate (l/p) ratio were measured by IPM.

    Results: Compared to baseline, ABO reduced IBF by 76% and decreased urinary output. SMA occlusion reduced IBF by 75% without affecting urinary output. ABO increased the i.p l/p ratio from 18 at baseline, peaking at 46 in early reperfusion. SMA occlusion and reperfusion tended to increase the i.p l/p ratio, peaking at 36 in early reperfusion. ABO increased the i.p glycerol concentration from 87 μM at baseline to 579 μM after three hours of reperfusion. SMA occlusion and reperfusion increased the i.p glycerol concentration but to a lesser degree.

    Conclusions: Supra-celiac ABO caused severe hemodynamic, renal and systemic metabolic disturbances compared to SMA occlusion, most likely due to the more extensive ischemiareperfusion injury. The intra-abdominal metabolism, measured by microdialysis, was affected both by ABO and SMA occlusion but the most severe disturbances were caused by ABO. The i.p l/p ratios and the glycerol concentrations increased during ischemia and reperfusion and may serve as markers of these events and indicate anaerobic metabolism and cell damage respectively.

  • 2.
    Hörer, Tal M.
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Örebro University Hospital. Department of Cardio-Thoracic and Vascular Surgery, Örebro University Hospital, Örebro, Sweden.
    Skoog, Per
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Department of Cardio-Thoracic and Vascular Surgery, Örebro University Hospital, Örebro, Sweden.
    Nilsson, Kristofer F.
    Örebro University Hospital. Örebro University, School of Medical Sciences. Department of Cardio-Thoracic and Vascular Surgery, Örebro University Hospital, Örebro, Sweden.
    Oikonomakis, Ioannis
    Department of Surgery, Örebro University Hospital, Örebro, Sweden.
    Larzon, Thomas
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Örebro University Hospital. Department of Cardio-Thoracic and Vascular Surgery, Örebro University Hospital, Örebro, Sweden.
    Norgren, Lars
    Örebro University, School of Health and Medical Sciences. Department of Surgery, Örebro University Hospital, Örebro, Sweden.
    Jansson, Kjell
    Department of Surgery, Örebro University Hospital, Örebro, Sweden.
    Intraperitoneal Metabolic Consequences of Supraceliac Aortic Balloon Occlusion in an Experimental Animal Study Using Microdialysis2014In: Annals of Vascular Surgery, ISSN 0890-5096, E-ISSN 1615-5947, Vol. 28, no 5, p. 1286-1295Article in journal (Refereed)
    Abstract [en]

    Background: To investigate the effects of supraceliac aortic balloon occlusion (ABO) and superior mesenteric artery (SMA) occlusion on abdominal visceral metabolism in an animal model using intraperitoneal microdialysis (IPM) and laser Doppler flowmetry.

    Methods: A total of 9 pigs were subjected to ABO and 7 animals were subjected to SMA occlusion for 1 hour followed by 3 hours of reperfusion. Seven animals served as controls. Hemodynamic data, arterial blood samples, urinary output, and intestinal mucosal blood flow (IBF) were followed hourly. Intraperitoneal (i.p) glucose, glycerol, lactate, and pyruvate concentrations and lactate-to-pyruvate (lip) ratio were measured using IPM.

    Results: Compared with the baseline, ABO reduced IBF by 76% and decreased urinary output. SMA occlusion reduced IBF by 75% without affecting urinary output. ABO increased the i.p lip ratio from 18 at baseline, peaking at 46 in early reperfusion. SMA occlusion and reperfusion tended to increase the i.p lip ratio, peaking at 36 in early reperfusion. ABO increased the i.p glycerol concentration from 87 mu M at baseline to 579 p,M after 3 hours of reperfusion. SMA occlusion and reperfusion increased The i.p glycerol concentration but to a lesser degree.

    Conclusions: Supraceliac ABO caused severe hemodynamic, renal, and systemic metabolic disturbances compared with SMA occlusion, most likely because of the more extensive ischemia-reperfusion injury. The intra-abdominal metabolism, measured by microdialysis, was affected by both ABO and SMA occlusion but the most severe disturbances were caused by ABO. The i.p lip ratios and the glycerol concentrations increased during ischemia and reperfusion and may serve as markers of these events and indicate anaerobic metabolism and cell damages respectively.

  • 3.
    Hörer, Tal M.
    et al.
    Örebro University Hospital. Department of Cardio-Vascular and Thoracic Surgery, Örebro University Hospital, Örebro, Sweden.
    Skoog, Per
    Department of Cardio-Vascular and Thoracic Surgery, Örebro University Hospital, Örebro, Sweden.
    Pirouzram, Artai
    Department of Cardio-Vascular and Thoracic Surgery, Örebro University Hospital, Örebro, Sweden.
    Larzon, Thomas
    Örebro University Hospital. Department of Cardio-Vascular and Thoracic Surgery, Örebro University Hospital, Örebro, Sweden.
    Tissue plasminogen activator-assisted hematoma evacuation to relieve abdominal compartment syndrome after endovascular repair of ruptured abdominal aortic aneurysm2012In: Journal of Endovascular Therapy, ISSN 1526-6028, E-ISSN 1545-1550, Vol. 19, no 2, p. 144-148Article in journal (Refereed)
    Abstract [en]

    Purpose: To describe our experience with a novel technique to decompress abdominal compartment syndrome after endovascular aneurysm repair (EVAR) of ruptured abdominal aortic aneurysm (rAAA).

    Method: From January 2003 to April 2010, 13 patients (12 men; mean age 75 years) treated for rAAA with EVAR underwent tissue plasminogen activator (tPA)-assisted decompression for intra-abdominal hypertension. All of the patients but one had intra-abdominal pressure >20 mmHg, with signs of multiple organ failure or abdominal perfusion pressure <60 mmHg. With computed tomography guidance, a drain was inserted into the retroperitoneal hematoma, and tPA solution was injected to facilitate evacuation of the coagulated hematoma and decrease the abdominal pressure.

    Results: In the 13 patients, the mean intra-abdominal pressure decreased from 23.5 mmHg (range 12-35) to 16 mmHg (range 10-28.5). A mean 1520 mL (range 170-2900) of blood was evacuated. Urine production (mean 130 mL/h, range 50-270) increased in 7 patients at 24 hours after tPA-assisted decompression; among the 5 patients in which urine output did not increase, 3 underwent hemodialysis by the 30-day follow-up. One patient did not respond with clinical improvement and required laparotomy. The 30-day, 90-day, and 1-year mortality was 38% (5/13 patients); none of the deaths was related to the decompression technique.

    Conclusion: tPA-assisted decompression of abdominal compartment syndrome after EVAR can decrease the intra-abdominal pressure and could be useful in preventing multiple organ failure. It is a minimally invasive technique that can be used in selected cases but does not replace laparotomy or retroperitoneal surgical procedures as the gold standard treatments. J Endovasc Thor. 2012;19:144-148

  • 4.
    Hörer, Tal
    et al.
    Örebro University Hospital. School of Health and Medical Sciences, Örebro University, Örebro, Sweden.
    Skoog, Per
    Örebro University Hospital, Örebro, Sweden; School of Health and Medical Sciences, Örebro University, Örebro, Sweden.
    Norgren, Lars
    School of Health and Medical Sciences, Örebro University, Örebro, Sweden; Örebro University Hospital, Örebro, Sweden.
    Magnuson, A.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Örebro University Hospital, Örebro, Sweden.
    Berggren, Lars
    School of Health and Medical Sciences, Örebro University, Örebro, Sweden; Örebro University Hospital, Örebro, Sweden.
    Jansson, Karl
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Örebro University Hospital, Örebro, Sweden.
    Larzon, Thomas
    School of Health and Medical Sciences, Örebro University, Örebro, Sweden; Örebro University Hospital, Örebro, Sweden.
    Intra-peritoneal microdialysis and intra-abdominal pressure after endovascular repair of ruptured aortic aneurysms2013In: European Journal of Vascular and Endovascular Surgery, ISSN 1078-5884, E-ISSN 1532-2165, Vol. 45, no 6, p. 596-606Article in journal (Refereed)
    Abstract [en]

    Objectives: This study aims to evaluate intra-peritoneal (ip) microdialysis after endovascular aortic repair (EVAR) of ruptured abdominal aortic aneurysm (rAAA) in patients developing intra-abdominal hypertension (IAH), requiring abdominal decompression.

    Design: Prospective study.

    Material and methods: A total of 16 patients with rAAA treated with an emergency EVAR were followed up hourly for intra-abdominal pressure (IAP), urine production and ip lactate, pyruvate, glycerol and glucose by microdialysis, analysed only at the end of the study. Abdominal decompression was performed on clinical criteria, and decompressed (D) and non-decompressed (ND) patients were compared.

    Results: The ip lactate/pyruvate (l/p) ratio was higher in the D group than in the ND group during the first five postoperative hours (mean 20 vs. 12), p = 0.005 and at 1 h prior to decompression compared to the fifth hour in the ND group (24 vs. 13), p = 0.016. Glycerol levels were higher in the D group during the first postoperative hours (mean 274.6 vs. 121.7 mu M), p = 0.022. The IAP was higher only at 1 h prior to decompression in the D group compared to the ND group at the fifth hour (mean 19 vs. 14 mmHg).

    Conclusions: lp l/p ratio and glycerol levels are elevated immediately postoperatively in patients developing IAH leading to organ failure and subsequent abdominal decompression.

  • 5.
    Hörer, Tal
    et al.
    Örebro University, School of Health and Medical Sciences.
    Toivola, Asko
    Larzon, Thomas
    Embolisation with Onyx in iatrogenic bleeding of the gluteal region2011In: Innovations (Philadelphia): technology and techniques in cardiothoracic and vascular surgery, ISSN 1556-9845, E-ISSN 1559-0879, Vol. 6, no 4, p. 267-270Article in journal (Refereed)
    Abstract [en]

    Purpose: We report a unique method using transcatheter Onyx embolization in a bleeding due to morphineinjection in the gluteal region.Case report: A 47 year-old man with a rare blood type presented a painful glutealhematoma due to iatrogenic injury. A Computed Tomographic Angiography (CTA) verified bleedingfrom a suspected branch of the deep femoral artery. Due to the unbearable pain, the hematoma wasevacuated by means of CT guided puncture and the insertion of a pigtail catheter combined with theinjection of a human plasminogen activation agent (t-PA). The initial result was positive. In order tostop the bleeding, angiographic embolization with Onyx was successfully used.Conclusions:Onyx can be used insmall vessel bleedings and might offer the advantage of selective embolization in cases where theaccess to the bleeding vessel is challenging or time consuming.

  • 6.
    Jonsson, Thomas B.
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Department of Surgery, Örebro University Hospital, Örebro, Sweden.
    Larzon, Thomas
    Department of Surgery, University Hospital, Örebro, Sweden.
    Arfvidsson, B.
    Department of Surgery, University Hospital, Örebro, Sweden.
    Tidefelt, Ulf
    Örebro University, School of Medicine, Örebro University, Sweden. Department of Medicine, University Hospital, Örebro, Sweden.
    Axelsson, C.-G.
    Department of Transfusion Medicine, University Hospital, Örebro, Sweden.
    Jurstrand, M.
    Clinical Research Centre, University Hospital, Örebro, Sweden.
    Norgren, Lars
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Department of Surgery, University Hospital, Örebro, Sweden.
    Adverse events during treatment limb ischemia with autologous peripheral blood mononuclear cell implant2012In: International Journal of Angiology, ISSN 0392-9590, E-ISSN 1827-1839, Vol. 31, no 1, p. 77-84Article in journal (Refereed)
    Abstract [en]

    Aim: Trials have reported clinical improvement and reduced need for amputation in critical limb ischemia (CLI) patients receiving therapeutic angiogenesis with stem cells. Our objective was to test peripheral stem cell therapy efficacy and safety to gain experiences for further work.

    Methods: We included nine CLI patients (mean age 76.7 ±9.7). Stem cells were mobilized to the peripheral blood by administration of G-CSF (Filgrastim) for 4 days, and were collected on day five, when 30 mL of a stem cell suspension was injected into 40 points of the limb. The clinical efficacy was evaluated by assessing pain relief, wound healing and changes in ankle-brachial pressure index (ABI). Local metabolic and inflammatory changes were measured with microdialysis, growth factors and cytokine level determination. Patients were followed for 24 weeks.

    Results: Four patients experienced some degree of improvement with pain relief and/or improved wound healing and ABI increase. One patient was lost to follow up due to chronic psychiatric illness; one was amputated after two weeks. Two patients had a myocardial infarction (MI), one died. One patient died from a massive mesenteric thrombosis after two weeks and one died from heart failure at week 11. Improved patients showed variable effects in cytokine-, growth factor- and local metabolic response.

    Conclusion: Even with some improvement in four patients, severe complications in four out of nine patients, and two in relation to the bone marrow stimulation, made us terminate the study prematurely. We conclude that with the increased risk and the reduced potential of the treatment, peripheral blood stem cell treatment in the older age group is less appropriate. Metabolic and inflammatory response may be of value to gain insight into mechanisms and possibly to evaluate effects of therapeutic angiogenesis.

  • 7. Jonsson, Thomas
    et al.
    Larzon, Thomas
    Örebro University, School of Health and Medical Sciences.
    Jansson, Kjell
    Arfvidsson, Berndt
    Norgren, Lars
    Örebro University, School of Health and Medical Sciences.
    Limb ischemia after EVAR: an effect of the obstructing introducer?2008In: Journal of Endovascular Therapy, ISSN 1526-6028, E-ISSN 1545-1550, Vol. 15, no 6, p. 695-701Article in journal (Refereed)
    Abstract [en]

    PURPOSE: To evaluate the splanchnic and limb metabolic effects of open repair (OR) of abdominal aortic aneurysms (AAA) versus endovascular aneurysm repair (EVAR) in a pilot study utilizing microdialysis. METHODS: Nine AAA patients (8 men; mean age 74 years, range 61-85) were treated with EVAR and 9 had an OR (5 men; mean age 70 years, range 55-85). In the EVAR cases, which were performed percutaneously, the external iliac artery was obstructed by the introducer to a mean functional stenosis of 70% (52%-100%). Catheters for microdialysis were placed subcutaneously above the ankle of the right leg and freely in the abdominal cavity to measure the levels of lactate and pyruvate. The lactate/pyruvate ratio was calculated as a measure of ischemia. Measurements started at the end of surgery and continued for 2 days. Mean values were compared using the Mann-Whitney U test. RESULTS: The mean value of intraperitoneal lactate during the first day after EVAR was 1.5+/-0.7 mM versus 2.6+/-0.8 mM after OR (p = 0.019). The lactate/pyruvate ratio was 10.2+/-2.2 after EVAR and 12.3+/-2.6 after OR (p = 0.113). Leg lactate mean values were 4.2+/-2.0 mM after EVAR versus 1.8+/-0.6 mM after OR (p<0.001). The lactate/pyruvate ratio was 20.1+/-8.3 for EVAR and 13.7+/-3.3 for OR (p = 0.040). These differences between EVAR and OR continued for the second day. CONCLUSION: Intraperitoneally, metabolism was slightly increased after OR; however, it was not suggestive of splanchnic ischemia. Leg findings reflected a more extensive ischemia after EVAR over 48 hours, which was a somewhat unexpected finding that may be related to the introducer's impact on blood flow to the limb during the intervention. Although no clinical consequences were recorded, the finding suggests some benefit of minimizing as much as possible the time of reduced perfusion to the limb.

  • 8.
    Larzon, Thomas
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Aspects of endovascular treatment of abdominal aortic aneurysms2012Doctoral thesis, comprehensive summary (Other academic)
    List of papers
    1. Endovascular treatment of ruptured abdominal aortic aneurysms: a shift of the paradigm?
    Open this publication in new window or tab >>Endovascular treatment of ruptured abdominal aortic aneurysms: a shift of the paradigm?
    2005 (English)In: Journal of Endovascular Therapy, ISSN 1526-6028, E-ISSN 1545-1550, Vol. 12, no 5, p. 548-555Article in journal (Refereed) Published
    Abstract [en]

    PURPOSE: To compare endovascular aneurysm repair (EVAR) of ruptured abdominal aortic aneurysms (rAAA) to the results with open surgery.

    METHODS: Between May 2001 and January 2004, 50 patients were diagnosed with rAAA. Fifteen (30%) patients (14 men; median age 73 years, range 58-85) underwent EVAR, while 26 (52%) patients (23 men; median age 75 years, range 60-84) had open surgery. Nine (18%) patients (5 men; median age 86 years, range 77-91) were not operated upon. Circulatory shock was defined as systolic blood pressure<80 mmHg. Mortality was defined as death within 30 days after operation; in cases where hospital stay exceeded 30 days, in-hospital mortality was registered. Five risk factors (age>76 years, loss of consciousness, hemoglobin<90 g/L, creatinine>190 micromol/L, and electrocardiographic ischemia) were analyzed.

    RESULTS: In the EVAR group, 93% (14/15) of the aneurysms were excluded from the bloodstream; there were 2 (13%) conversions: 1 intraoperatively for stent-graft migration and another owing to dissection prior to hospital discharge. Mortality after open surgery was 46% (12/26) versus 13% (2/15) in the EVAR group (p>0.05). Univariate analysis without considering variables other than mortality resulted in OR 5.4 (95% CI 0.9 to 58; p=0.07). Considering risk factors and shock, multivariate analysis resulted in OR 6.5 (95% CI 0.8 to 96; p=0.08). In the EVAR group, 60% (9/15) had complications; in the group with open surgery, the complication rate was 85% (22/26; p=0.13).

    CONCLUSIONS: It is possible to treat rAAA with EVAR. Hypotensive patients can, at least initially, be operated under local anesthesia to stabilize blood pressure utilizing a percutaneously inserted occlusion balloon. There was a trend in our study for reduced mortality and morbidity with EVAR, but further studies are required to conclude whether EVAR significantly increases survival and reduces complications.

    National Category
    Surgery
    Research subject
    Surgery
    Identifiers
    urn:nbn:se:oru:diva-26546 (URN)10.1583/04-1469.1 (DOI)16212454 (PubMedID)
    Available from: 2012-11-29 Created: 2012-11-29 Last updated: 2017-12-07Bibliographically approved
    2. Fascia suturing of large access sites after endovascular treatment of aortic aneurysms and dissections
    Open this publication in new window or tab >>Fascia suturing of large access sites after endovascular treatment of aortic aneurysms and dissections
    Show others...
    2006 (English)In: Journal of Endovascular Therapy, ISSN 1526-6028, E-ISSN 1545-1550, Vol. 13, no 2, p. 152-157Article in journal (Refereed) Published
    Abstract [en]

    PURPOSE: To evaluate a technique for closure of a femoral artery access in which the cribriform fascia covering the common femoral artery is sutured.

    METHODS: A consecutive series of 127 patients (103 men; median age 74 years, range 45- 89) underwent endovascular aortic aneurysm repair between August 2001 and September 2004. Twelve patients underwent a secondary intervention for a total of 139 procedures in the group. Sixty-one (43.9%) of the 139 operations were acute. Among the 257 femoral arteries used for access, a fascia suturing technique was performed in 131 (51.0%). Data were collected for analysis of access site complications, bleeding, thrombosis, pseudoaneurysm, and stenosis. A subgroup of 72 patients had ankle-brachial indexes (ABI) recorded; another subgroup of 50 patients were also investigated by duplex ultrasonography.

    RESULTS: Complications occurred in 18 (13.7%) of the 131 sutured cases. The majority (n = 16) arose within 24 hours: 8 cases of perioperative bleeding or thrombosis required open surgery and 8 cases were reoperated within 24 hours for bleeding (n = 4), thrombosis (n = 3), and 1 intimal dissection. The acute failure rate was 12.2%. Two patients had late complications: 1 case of neuralgia and 1 pseudoaneurysm that required acute surgery 28 months postoperatively. The ABI did not change significantly from pre- to postoperatively in the 72 patients examined. Five patients with stenoses did not have a reduction in ABI. In the 66 sites examined with ultrasound in 50 patients, 3 minor pseudoaneurysms were detected.

    CONCLUSION: The fascia suturing technique for closure of a femoral artery access during endovascular repair of aortic diseases is feasible, even in acute situations. Failures can be managed easily. Late complications requiring additional procedures are rare.

    National Category
    Surgery
    Research subject
    Surgery
    Identifiers
    urn:nbn:se:oru:diva-26547 (URN)10.1583/05-1719R.1 (DOI)16643069 (PubMedID)
    Available from: 2012-11-29 Created: 2012-11-29 Last updated: 2017-12-07Bibliographically approved
    3. A randomized controlled trial of the fascia suture technique compared with a suture-mediated closure device for femoral arterial closure after endovascular aortic repair
    Open this publication in new window or tab >>A randomized controlled trial of the fascia suture technique compared with a suture-mediated closure device for femoral arterial closure after endovascular aortic repair
    Show others...
    (English)Manuscript (preprint) (Other academic)
    National Category
    Surgery
    Research subject
    Surgery
    Identifiers
    urn:nbn:se:oru:diva-26549 (URN)
    Available from: 2012-11-29 Created: 2012-11-29 Last updated: 2017-10-17Bibliographically approved
    4. Complete replacement of open repair for ruptured abdominal aortic aneurysms by endovascular aneurysm repair: a two-center 14-year experience
    Open this publication in new window or tab >>Complete replacement of open repair for ruptured abdominal aortic aneurysms by endovascular aneurysm repair: a two-center 14-year experience
    Show others...
    2012 (English)In: Annals of Surgery, ISSN 0003-4932, E-ISSN 1528-1140, Vol. 256, no 5, p. 688-696Article in journal (Refereed) Published
    Abstract [en]

    Objective: To present the combined 14-year experience of 2 university centers performing endovascular aneurysm repair (EVAR) on 100% of noninfected ruptured abdominal aortic aneurysms (RAAA) over the last 32 months.

    Background: : Endovascular aneurysm repair for RAAA feasibility is reported to be 20% to 50%, and EVAR for RAAA has been reported to have better outcomes than open repair.

    Methods: We retrospectively analyzed prospectively gathered data on 473 consecutive RAAA patients (Zurich, 295; Örebro, 178) from January 1, 1998, to December 31, 2011, treated by an "EVAR-whenever-possible" approach until April 2009 (EVAR/OPEN period) and thereafter according to a "100% EVAR" approach (EVAR-ONLY period).Straightforward cases were treated by standard EVAR. More complex RAAA were managed during EVAR-ONLY with adjunctive procedures in 17 of 70 patients (24%): chimney, 3; open iliac debranching, 1; coiling, 8; onyx, 3; and chimney plus onyx, 2.

    Results: Since May 2009, all RAAA but one have been treated by EVAR (Zurich, 31; Örebro, 39); 30-day mortality for EVAR-ONLY was 24% (17 of 70). Total cohort mortality (including medically treated patients) for EVAR/OPEN was 32.8% (131 of 400) compared with 27.4% (20 of 73) for EVAR-ONLY (P = 0.376). During EVAR/OPEN, 10% (39 of 400) of patients were treated medically compared with 4% (3 of 73) of patients during EVAR-ONLY. In EVAR/OPEN, open repair showed a statistically significant association with 30-day mortality (adjusted odds ratio [OR] = 3.3; 95% confidence interval [CI], 1.4-7.5; P = 0.004). For patients with no abdominal decompression, there was a higher mortality with open repair than EVAR (adjusted OR = 5.6; 95% CI, 1.9-16.7). In patients with abdominal decompression by laparotomy, there was no difference in mortality (adjusted OR = 1.1; 95% CI, 0.3-3.7).

    Conclusions: The "EVAR-ONLY" approach has allowed EVAR treatment of nearly all incoming RAAA with low mortality and turndown rates. Although the observed association of a higher EVAR mortality with abdominal decompression needs further study, our results support superiority and more widespread adoption of EVAR for the treatment of RAAA.

    Place, publisher, year, edition, pages
    Philadelphia, USA: Lippincott Williams & Wilkins, 2012
    Keywords
    Abdominal compartment syndrome, abdominal decompression, chimney graft, debranching, endovascular repair, open abdomen treatment, open repair, ruptured abdominal aortic aneurysm
    National Category
    Surgery
    Research subject
    Surgery
    Identifiers
    urn:nbn:se:oru:diva-26548 (URN)10.1097/SLA.0b013e318271cebd (DOI)000311223300006 ()23095611 (PubMedID)2-s2.0-84872026584 (Scopus ID)
    Available from: 2012-11-29 Created: 2012-11-29 Last updated: 2018-05-10Bibliographically approved
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  • 9.
    Larzon, Thomas
    et al.
    Örebro University, Department of Clinical Medicine.
    Friberg, Örjan
    Lund, Philip
    Eliasson, Ken
    Ågren, Göran
    Arbeus, Mikael
    Intrakardiell leiomyomatos - benign tumör som kan ge dödligt förlopp: radikal kirurgi ger säkraste resultat2006In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 103, no 30-31, p. 2220-2222Article in journal (Refereed)
  • 10.
    Larzon, Thomas
    et al.
    Örebro University, Department of Clinical Medicine.
    Geijer, Håkan
    Gruber, Göran
    Popek, Robert
    Norgren, Lars
    Fascia suturing of large access sites after endovascular treatment of aortic aneurysms and dissections2006In: Journal of Endovascular Therapy, ISSN 1526-6028, E-ISSN 1545-1550, Vol. 13, no 2, p. 152-157Article in journal (Refereed)
    Abstract [en]

    PURPOSE: To evaluate a technique for closure of a femoral artery access in which the cribriform fascia covering the common femoral artery is sutured.

    METHODS: A consecutive series of 127 patients (103 men; median age 74 years, range 45- 89) underwent endovascular aortic aneurysm repair between August 2001 and September 2004. Twelve patients underwent a secondary intervention for a total of 139 procedures in the group. Sixty-one (43.9%) of the 139 operations were acute. Among the 257 femoral arteries used for access, a fascia suturing technique was performed in 131 (51.0%). Data were collected for analysis of access site complications, bleeding, thrombosis, pseudoaneurysm, and stenosis. A subgroup of 72 patients had ankle-brachial indexes (ABI) recorded; another subgroup of 50 patients were also investigated by duplex ultrasonography.

    RESULTS: Complications occurred in 18 (13.7%) of the 131 sutured cases. The majority (n = 16) arose within 24 hours: 8 cases of perioperative bleeding or thrombosis required open surgery and 8 cases were reoperated within 24 hours for bleeding (n = 4), thrombosis (n = 3), and 1 intimal dissection. The acute failure rate was 12.2%. Two patients had late complications: 1 case of neuralgia and 1 pseudoaneurysm that required acute surgery 28 months postoperatively. The ABI did not change significantly from pre- to postoperatively in the 72 patients examined. Five patients with stenoses did not have a reduction in ABI. In the 66 sites examined with ultrasound in 50 patients, 3 minor pseudoaneurysms were detected.

    CONCLUSION: The fascia suturing technique for closure of a femoral artery access during endovascular repair of aortic diseases is feasible, even in acute situations. Failures can be managed easily. Late complications requiring additional procedures are rare.

  • 11.
    Larzon, Thomas
    et al.
    Örebro University, Department of Clinical Medicine.
    Lindgren, Rickard
    Norgren, Lars
    Endovascular treatment of ruptured abdominal aortic aneurysms: a shift of the paradigm?2005In: Journal of Endovascular Therapy, ISSN 1526-6028, E-ISSN 1545-1550, Vol. 12, no 5, p. 548-555Article in journal (Refereed)
    Abstract [en]

    PURPOSE: To compare endovascular aneurysm repair (EVAR) of ruptured abdominal aortic aneurysms (rAAA) to the results with open surgery.

    METHODS: Between May 2001 and January 2004, 50 patients were diagnosed with rAAA. Fifteen (30%) patients (14 men; median age 73 years, range 58-85) underwent EVAR, while 26 (52%) patients (23 men; median age 75 years, range 60-84) had open surgery. Nine (18%) patients (5 men; median age 86 years, range 77-91) were not operated upon. Circulatory shock was defined as systolic blood pressure<80 mmHg. Mortality was defined as death within 30 days after operation; in cases where hospital stay exceeded 30 days, in-hospital mortality was registered. Five risk factors (age>76 years, loss of consciousness, hemoglobin<90 g/L, creatinine>190 micromol/L, and electrocardiographic ischemia) were analyzed.

    RESULTS: In the EVAR group, 93% (14/15) of the aneurysms were excluded from the bloodstream; there were 2 (13%) conversions: 1 intraoperatively for stent-graft migration and another owing to dissection prior to hospital discharge. Mortality after open surgery was 46% (12/26) versus 13% (2/15) in the EVAR group (p>0.05). Univariate analysis without considering variables other than mortality resulted in OR 5.4 (95% CI 0.9 to 58; p=0.07). Considering risk factors and shock, multivariate analysis resulted in OR 6.5 (95% CI 0.8 to 96; p=0.08). In the EVAR group, 60% (9/15) had complications; in the group with open surgery, the complication rate was 85% (22/26; p=0.13).

    CONCLUSIONS: It is possible to treat rAAA with EVAR. Hypotensive patients can, at least initially, be operated under local anesthesia to stabilize blood pressure utilizing a percutaneously inserted occlusion balloon. There was a trend in our study for reduced mortality and morbidity with EVAR, but further studies are required to conclude whether EVAR significantly increases survival and reduces complications.

  • 12.
    Larzon, Thomas
    et al.
    Örebro University Hospital. Department of Cardiothoracic and Vascular Surgery, Örebro University Hospital, Örebro, Sweden.
    Roos, H.
    Department of Vascular Surgery, Sahlgrenska University Hospital, Göteborg, Sweden .
    Gruber, G.
    Department of Cardiothoracic and Vascular Surgery, Faculty of Medicine and Vascular Surgery, Örebro University Hospital, Örebro, Sweden.
    Henrikson, O.
    Department of Radiology, Sahlgrenska University Hospital, Göteborg, Sweden .
    Magnuson, A.
    Clinical Epidemiology and Biostatistics, Faculty of Medicine and Health, Örebro University, Örebro, Sweden .
    Falkenberg, M.
    Department of Radiology, Sahlgrenska University Hospital, Göteborg, Sweden.
    Lönn, L.
    Department of Vascular Surgery and Radiology, National Hospital Copenhagen (Rigshospitalet), Copenhagen, Denmark .
    Norgren, L.
    Department of Surgery, Faculty of Medicine and Vascular Surgery, Örebro University, Örebro, Sweden .
    Editor's choice: a randomized controlled trial of the fascia suture technique compared with a suture-mediated closure device for femoral arterial closure after endovascular aortic repair2015In: European Journal of Vascular and Endovascular Surgery, ISSN 1078-5884, E-ISSN 1532-2165, Vol. 49, no 2, p. 166-173Article in journal (Refereed)
    Abstract [en]

    Objectives: The aim was to investigate whether the fascia suture technique (FST) can reduce access closure time and procedural costs compared with the Prostar technique (Prostar) in patients undergoing endovascular aortic repair and to evaluate the short- and mid-term outcomes of both techniques.

    Methods: In this two center trial, 100 patients were randomized to access closure by either FST or Prostar between June 2006 and December 2009. The primary endpoint was access closure time. Secondary outcome measures included access related costs and evaluation of the short- and mid-term complications. Evaluation was performed pen- and post-operatively, at discharge, at 30 days and at 6 months follow up.

    Results: The median access closure time was 12.4 minutes for FST and 19.9 minutes for Prostar (p < .001). Prostar required a 54% greater procedure time than FST, mean ratio 1.54 (95% Cl 1.25-1.90, p < .001) according to regression analysis. Adjusted for operator experience the mean ratio was 1.30 (95% Cl 1.09-1.55, p = .005) and for patient body mass index 1.59 (95% Cl 1.28-1.96, p < .001). The technical failure rate for operators at proficiency level was 5% (2/40) compared with 28% (17/59) for those at the basic level (p = .003). The proficiency level group had a technical failure rate of 4% (1/26) for FST and 7% (1/14) for Prostar, p = 1.00, while corresponding rates for the basic level group were 27% (6/22) for FST and 30% (11/37) for Prostar (p = .84). There was a significant difference in cost in favor. of FST, with a median difference of (sic)800 (95% Cl 710-927, p < .001).

    Conclusions: In aortic endovascular repair FST is a faster and cheaper technique than the Prostar technique.

  • 13.
    Larzon, Thomas
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Roos, Håkan
    Gruber, Göran
    Henrikson, Olof
    Magnuson, Anders
    Falkenberg, Mårten
    Lönn, Lars
    Norgren, Lars
    A randomized controlled trial of the fascia suture technique compared with a suture-mediated closure device for femoral arterial closure after endovascular aortic repairManuscript (preprint) (Other academic)
  • 14. Malina, Martin
    et al.
    Blohmé, Linus
    Falkenberg, Mårten
    Ivancev, Krassi
    Larzon, Thomas
    Örebro University, School of Health and Medical Sciences.
    Resch, Tim
    Sonesson, Björn
    Endovaskulär behandling är visst bättre än öppenkirurgi för många patienter med bukaortaaneurysm2006In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 103, no 20, p. 1632-1633Article in journal (Refereed)
  • 15.
    Mathisen, Sven R.
    et al.
    Department of Vascular Surgery, Sykehuset innlandet, Hamar, Norway.
    Zimmermann, Eric
    Department of Vascular Radiology, Sykehuset innlandet, Hamar, Norway.
    Markström, Ulf
    Department of Vascular Surgery, Sykehuset innlandet, Hamar, Norway.
    Mattsson, Kjell
    Department of Vascular Radiology, Sykehuset innlandet, Hamar, Norway.
    Larzon, Thomas
    Department of Cardiothoracic and Vascular Surgery, Örebro University Hospital, Örebro, Sweden.
    Complication rate of the fascia closure technique in endovascular aneurysm repair2012In: Journal of Endovascular Therapy, ISSN 1526-6028, E-ISSN 1545-1550, Vol. 19, no 3, p. 392-396Article in journal (Refereed)
    Abstract [en]

    Purpose: To assess the rate of complications associated with the fascia closure technique for femoral access sites in which 18-F or 20-F sheaths were introduced during endovascular aneurysm repair (EVAR).

    Methods: A retrospective analysis was done of 50 consecutive patients (41 men; median age 75 years, range 62-85) who received Excluder stent-grafts in planned percutaneous EVAR procedures from May 2006 until December 2009. The fascia closure technique was routinely used for all femoral access sites in which large bore (18-F and 20-F) introducers were employed. One patient with extremely calcified and narrowed vessels was converted to primary cutdown bilaterally after percutaneous access failed. In the 49 remaining patients, 81 femoral access sites were closed with the fascia closure technique; 17 sites with smaller 12-F introducers were closed using other techniques. Computed tomographic angiography (CTA) was performed within 30 days, at 6 months, and at 1, 2, and 3 years.

    Results: Of the 81 femoral access sites closed with the fascia closure technique, only 1 patient had persistent bleeding that required an immediate cutdown and suture repair of the deep femoral artery (99.0% technical success rate). In the immediate postoperative period, 5 patients required additional interventions for bleeding (n = 2), occlusion (n = 2), or a pseudoaneurysm [92.6% 30-day technical success]. At 30 days, 11 (13.9%) of 79 access sites had pseudoaneurysms, all of which resolved within a year; none required a secondary intervention. Later surveillance scans did not detect pseudoaneurysms.

    Conclusion: The fascia closure technique during EVAR is safe and has few complications. The low frequencies of pseudoaneurysms and other access site complications make the femoral closure technique a durable alternative.

  • 16.
    Mayer, D.
    et al.
    Clinic for Cardiovascular Surgery, University Hospital of Zurich, Zurich, Switzerland.
    Aeschbacher, S.
    Clinic for Cardiovascular Surgery, University Hospital of Zurich, Zurich, Switzerland.
    Pfammatter, T.
    Clinic for Cardiovascular Surgery, University Hospital of Zurich, Zurich, Switzerland.
    Veith, F. J.
    The Cleveland Clinic, Cleveland OH, USA; New York University Medical Center, New York, USA.
    Norgren, Lars
    Department of Surgery, Örebro University Hospital, Örebro, Sweden.
    Magnuson, A.
    Clinical Epidemiology and Biostatistic Unit, Örebro University Hospital, Örebro, Sweden.
    Rancic, Z.
    Clinic for Cardiovascular Surgery, University Hospital of Zurich, Zurich, Switzerland.
    Lachat, M.
    Clinic for Cardiovascular Surgery, University Hospital of Zurich, Zurich, Switzerland.
    Larzon, Thomas
    Department of Cardio-Thoracic and Vascular Surgery, Örebro University Hospital, Örebro, Sweden.
    Complete replacement of open repair for ruptured abdominal aortic aneurysms by endovascular aneurysm repair: a two-center 14-year experience2012In: Annals of Surgery, ISSN 0003-4932, E-ISSN 1528-1140, Vol. 256, no 5, p. 688-696Article in journal (Refereed)
    Abstract [en]

    Objective: To present the combined 14-year experience of 2 university centers performing endovascular aneurysm repair (EVAR) on 100% of noninfected ruptured abdominal aortic aneurysms (RAAA) over the last 32 months.

    Background: : Endovascular aneurysm repair for RAAA feasibility is reported to be 20% to 50%, and EVAR for RAAA has been reported to have better outcomes than open repair.

    Methods: We retrospectively analyzed prospectively gathered data on 473 consecutive RAAA patients (Zurich, 295; Örebro, 178) from January 1, 1998, to December 31, 2011, treated by an "EVAR-whenever-possible" approach until April 2009 (EVAR/OPEN period) and thereafter according to a "100% EVAR" approach (EVAR-ONLY period).Straightforward cases were treated by standard EVAR. More complex RAAA were managed during EVAR-ONLY with adjunctive procedures in 17 of 70 patients (24%): chimney, 3; open iliac debranching, 1; coiling, 8; onyx, 3; and chimney plus onyx, 2.

    Results: Since May 2009, all RAAA but one have been treated by EVAR (Zurich, 31; Örebro, 39); 30-day mortality for EVAR-ONLY was 24% (17 of 70). Total cohort mortality (including medically treated patients) for EVAR/OPEN was 32.8% (131 of 400) compared with 27.4% (20 of 73) for EVAR-ONLY (P = 0.376). During EVAR/OPEN, 10% (39 of 400) of patients were treated medically compared with 4% (3 of 73) of patients during EVAR-ONLY. In EVAR/OPEN, open repair showed a statistically significant association with 30-day mortality (adjusted odds ratio [OR] = 3.3; 95% confidence interval [CI], 1.4-7.5; P = 0.004). For patients with no abdominal decompression, there was a higher mortality with open repair than EVAR (adjusted OR = 5.6; 95% CI, 1.9-16.7). In patients with abdominal decompression by laparotomy, there was no difference in mortality (adjusted OR = 1.1; 95% CI, 0.3-3.7).

    Conclusions: The "EVAR-ONLY" approach has allowed EVAR treatment of nearly all incoming RAAA with low mortality and turndown rates. Although the observed association of a higher EVAR mortality with abdominal decompression needs further study, our results support superiority and more widespread adoption of EVAR for the treatment of RAAA.

  • 17.
    McGreevy, David Thomas
    et al.
    Department of Cardiothoracic and Vascular Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Abu-Zidan, Fikri M.
    Department of Surgery, College of Medicine and Health Science, UAE University, Al-Ain, United Arab Emirates.
    Sadeghi, Mitra
    Department of Cardiothoracic and Vascular Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Pirouzram, Artai
    Örebro University, School of Medical Sciences. Department of Cardiothoracic and Vascular Surgery.
    Toivola, Asko
    Department of Cardiothoracic and Vascular Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Skoog, Per
    Department of Hybrid and Interventional Surgery, Unit of Vascular Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden.
    Idoguchi, Koji
    Senshu Trauma and Critical Care Center, Rinku General Medical Center, Izumisano, Japan.
    Kon, Yuri
    Emergency and Critical Care Center, Hachinohe City Hospital, Hachinohe, Japan.
    Ishida, Tokiya
    Emergency and Critical Care Center, Ohta Nishinouchi Hospital, Koriyama, Japan.
    Matsumura, Yosuke
    Department of Emergency and Critical Care Medicine, Chiba University Graduate School of Medicine, Chiba, Japan.
    Matsumoto, Junichi
    Department of Emergency and Critical Care Medicine, St Marianna University School of Medicine, Kawasaki, Japan.
    Reva, Viktor
    Department of War Surgery, Kirov Military Medical Academy, Saint Petersburg, RussiaDzhanelidze Research Institute of Emergency Medicine, Saint Petersburg, Russia .
    Maszkowski, Mariusz
    Västmanlands Hospital Västerås, Department of Vascular Surgery, Örebro University, Örebro, Sweden.
    Bersztel, Adam
    Västmanlands Hospital Västerås, Department of Vascular Surgery, Örebro University, Örebro, Sweden.
    Caragounis, Eva-Corina
    Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg and Sahlgrenska University Hospital, Gothenburg, Sweden.
    Falkenberg, Mårten
    Department of Radiology, Sahlgrenska University Hospital, Gothenburg, Sweden.
    Handolin, Lauri
    Helsinki University Hospital, Department of Orthopedics and Traumatology, University of Helsinki, Helsinki, Finland.
    Oosthuizen, George
    Ngwelezana Surgery and Trauma, Department of Surgery, University of KwaZulu-Natal, Empangeni, KwaZulu-Natal, South Africa.
    Szarka, Endre
    Pietermaritzburg Metropolitan Trauma Service, Department of Surgery, University of KwaZulu-Natal College of Health Sciences, Pietermaritzburg, KwaZulu-Natal, South Africa.
    Manchev, Vassil
    Department of Surgery. Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
    Wannatoop, Tongporn
    Department of Surgery. Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
    Chang, Sung Wook
    Department of Thoracic and Cardiovascular Surgery, Trauma Center, Dankook University Hospital, Cheonan, Republic of Korea.
    Kessel, Boris
    Department of Surgery, Hillel Yaffe Medical Centre, Hadera, Israel.
    Hebron, Dan
    Department of Surgery, Hillel Yaffe Medical Centre, Hadera, Israel.
    Shaked, Gad
    Department of Anesthesiology and Critical Care, Soroka University Medical Center, Ben Gurion University, Beer Sheva, Israel.
    Bala, Miklosh
    Trauma and Acute Care Surgery Unit, Hadassah Hebrew University Medical Center, Jerusalem, Israel.
    Coccolini, Federico
    Department of General, Emergency and Trauma Surgery, Bufalini Hospital, Cesena, Italy.
    Ansaloni, Luca
    Department of General, Emergency and Trauma Surgery, Bufalini Hospital, Cesena, Italy.
    Ordoñez, Carlos A
    Division of Trauma and Acute Care Surgery, Department of Surgery, Fundación Valle del Lili and Universidad Del Valle, Cali, Colombia.
    Dogan, Emanuel M.
    Örebro University, School of Medical Sciences. Department of Cardiothoracic and Vascular Surgery.
    Manning, James E.
    Department of Emergency Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America.
    Hibert-Carius, Peter
    Department of Anesthesiology, Emergency and Intensive Care Medicine, Bergmannstrost Hospital Halle, Halle, Germany.
    Larzon, Thomas
    Department of Cardiothoracic and Vascular Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Nilsson, Kristofer F.
    Örebro University, School of Medical Sciences. Department of Cardiothoracic and Vascular Surgery.
    Hörer, Tal Martin
    Örebro University, School of Medical Sciences. Örebro University Hospital. Department of Cardiothoracic and Vascular Surgery.
    Feasibility and Clinical Outcome of Reboa in Patients with Impending Traumatic Cardiac Arrest2019In: Shock, ISSN 1073-2322, E-ISSN 1540-0514Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) may improve Systolic Blood Pressure (SBP) in hypovolemic shock. It has, however, not been studied in patients with impending traumatic cardiac arrest (ITCA). We aimed to study the feasibility and clinical outcome of REBOA in patients with ITCA using data from the ABOTrauma Registry.

    METHODS: Retrospective and prospective data on the use of REBOA from 16 centers globally were collected. SBP was measured both at pre- and post-REBOA inflation. Data collected included patients' demography, vascular access technique, number of attempts, catheter size, operator, zone and duration of occlusion, and clinical outcome.

    RESULTS: There were 74 patients in this high-risk patient group. REBOA was performed on all patients. A 7-10Fr catheter was used in 66.7%, 58.5% were placed on the first attempt, 52.1% through blind insertion and 93.2% inflated in Zone I, 64.8% for a period of 30 to 60 minutes, 82.1% by ER doctors, trauma surgeons or vascular surgeons. SBP significantly improved to 90 mmHg following the inflation of REBOA. 36.6% of the patients survived.

    CONCLUSIONS: Our study has shown that REBOA may be performed in patients with ITCA, SBP can be elevated and 36.6% of the patients survived if REBOA placement is successful.

  • 18.
    Norgren, Lars
    et al.
    Örebro University, School of Health and Medical Sciences.
    Larzon, Thomas
    Örebro University, School of Health and Medical Sciences.
    Endovascular repair of the ruptured abdominal aortic aneurysm2008In: Scandinavian Journal of Surgery, ISSN 1457-4969, E-ISSN 1799-7267, Vol. 97, no 2, p. 178-181; discussion 181-2Article in journal (Refereed)
    Abstract [en]

    The present knowledge on endovascular repair of ruptured abdominal aortic aneurysms (rAAA) prevents firm conclusions when to use this method in comparison to open repair. This review article briefly summarizes results from case series, and discusses how to achieve reliable information despite the absence of randomized controlled trials. At present a careful conclusion might be that dedicated centers with an adequate organization and reasonably high volume of abdominal aortic aneurysm (AAA) should use detailed registry protocols to achieve experience and data to create an as reliable basis as possible for future recommendations.

  • 19.
    Norgren, Lars
    et al.
    Örebro University, School of Health and Medical Sciences.
    Larzon, Thomas
    Örebro University, School of Health and Medical Sciences.
    Endovascular repair of the ruptured abdominal aortic aneurysm: editorial2008In: Vascular Medicine, ISSN 1358-863X, E-ISSN 1477-0377, Vol. 13, no 1, p. 45-46Article in journal (Refereed)
  • 20.
    Skoog, Per
    et al.
    Department of Cardio-Thoracic and Vascular Surgery, Örebro University Hospital, Örebro, Sweden.
    Hörer, Tal M.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Department of Cardio-Thoracic and Vascular Surgery, Örebro University Hospital, Örebro, Sweden.
    Nilsson, Kristofer. F.
    Department of Cardio-Thoracic and Vascular Surgery, Örebro University Hospital, Örebro, Sweden.
    Norgren, Lars
    Dept Surg, Orebro Univ Hosp, Orebro, Sweden.
    Larzon, Thomas
    Department of Cardio-Thoracic and Vascular Surgery, Örebro University Hospital, Örebro, Sweden.
    Jansson, Kjell
    Dept Surg, Orebro Univ Hosp, Orebro, Sweden.
    Abdominal Hypertension and Decompression: The Effect on Peritoneal Metabolism in an Experimental Porcine Study2014Manuscript (preprint) (Other academic)
    Abstract [en]

    Objective: This study aims to investigate the abdominal metabolic response and circulatory changes after decompression of intra-abdominal hypertension in a porcine model. Design: Prospective study with controls. Setting: University hospital research laboratory.

    Subjects: Three-months old domestic pigs of both sexes. Interventions: The animals were anesthetised and ventilated. Nine animals had a pneumoperitoneum-induced intra-abdominal hypertension of 30 mmHg for six hours. Twelve animals had corresponding intra-abdominal hypertension for four hours followed by decompression and were monitored for another two hours.

    Measurements and Main Results: Hemodynamics, urine output and arterial blood samples were analysed. Laserdoppler measured mucosal blood flow and urine output decreased with pressure induction and showed a statistically significant restitution after decompression. Glucose, glycerol, lactate and pyruvate concentrations and lactate-pyruvate (l/p) ratio were measured by microdialysis. Both groups developed distinct metabolic changes intraperitoneally at pressure induction including an increased l/p ratio as signs of organ hypoperfusion. In the decompression group the intraperitoneal l/p ratio normalised during the second decompression hour, indicating partially restored perfusion.

    Conclusions: Decompression after four hours of intra-abdominal hypertension results in restoration of intestinal blood flow and normalised intraperitoneal metabolism.

  • 21. Veith, Frank J.
    et al.
    Lachat, Mario
    Mayer, Dieter
    Malina, Martin
    Holst, Jan
    Mehta, Manish
    Verhoeven, Eric L. G.
    Larzon, Thomas
    Örebro University, School of Health and Medical Sciences.
    Gennai, Stefano
    Coppi, Gioacchino
    Lipsitz, Evan C.
    Gargiulo, Nicholas J.
    van der Vliet, J. Adam
    Blankensteijn, Jan
    Buth, Jacob
    Lee, W. Anthony
    Biasi, Giorgio
    Deleo, Gaetano
    Kasirajan, Karthikeshwar
    Moore, Randy
    Soong, Chee V.
    Cayne, Neal S.
    Farber, Mark A.
    Raithel, Dieter
    Greenberg, Roy K.
    van Sambeek, Marc R. H. M.
    Brunkwall, Jan S.
    Rockman, Caron B.
    Hinchliffe, Robert J.
    Collected world and single center experience with endovascular treatment of ruptured abdominal aortic aneurysms2009In: Annals of Surgery, ISSN 0003-4932, E-ISSN 1528-1140, Vol. 250, no 5, p. 818-824Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Case and single center reports have documented the feasibility and suggested the effectiveness of endovascular aneurysm repair (EVAR) of ruptured abdominal aortic aneurysms (RAAAs), but the role and value of such treatment remain controversial. OBJECTIVE: To clarify these we examined a collected experience with use of EVAR for RAAA treatment from 49 centers. METHODS: Data were obtained by questionnaires from these centers, updated from 13 centers committed to EVAR treatment whenever possible and included treatment details from a single center and information on 1037 patients treated by EVAR and 763 patients treated by open repair (OR). RESULTS: Overall 30-day mortality after EVAR in 1037 patients was 21.2%. Centers performing EVAR for RAAAs whenever possible did so in 28% to 79% (mean 49.1%) of their patients, had a 30-day mortality of 19.7% (range: 0%-32%) for 680 EVAR patients and 36.3% (range: 8%-53%) for 763 OR patients (P < 0.0001). Supraceliac aortic balloon control was obtained in 19.1% +/- 12.0% (+/-SD) of 680 EVAR patients. Abdominal compartment syndrome was treated by some form of decompression in 12.2% +/- 8.3% (+/-SD) of these EVAR patients. CONCLUSION: These results indicate that EVAR has a lower procedural mortality at 30 days than OR in at least some patients and that EVAR is better than OR for treating RAAA patients provided they have favorable anatomy; adequate skills, facilities, and protocols are available; and optimal strategies, techniques, and adjuncts are employed.

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