Maarit Venermo - Academia.edu (original) (raw)
Papers by Maarit Venermo
Scandinavian journal of surgery : SJS : official organ for the Finnish Surgical Society and the Scandinavian Surgical Society, 2005
It is difficult to assess the severity and location of venous insufficiency in legs with recurren... more It is difficult to assess the severity and location of venous insufficiency in legs with recurrent varicose disease. This present purpose was to evaluate the distribution of reflux and the diagnostic role of current classifications in a consecutive series of legs with previously operated varicose disease. A total of 90 legs in a cohort of 66 patients were included. The examination comprised CEAP clinical class, clinical disability score (CDS) and leg symptoms. Colour-flow duplex imaging (CFDI) was used to observe reflux in deep and superficial veins. Details of prior surgery were assessed. The site of superficial reflux was at the groin in 58% (recurrent or residive vein trunk or unoperated great saphenous vein), and the rate in the popliteal fossa was 11% (unoperated short saphenous vein). In 58% of the legs presenting superficial reflux at groin level, previous surgery at the saphenofemoral junction was noted. A sensation of pain was observed in 74% of the legs, sensation of oedem...
European Journal of Vascular and Endovascular Surgery, 2010
Objective: This study aims to evaluate mortality across ankle-brachial index (ABI) values and to ... more Objective: This study aims to evaluate mortality across ankle-brachial index (ABI) values and to assess the association between elevated ABI, peripheral arterial disease (PAD) and mortality.
Aging Clinical and Experimental Research, 2008
The purpose of this study was to characterize the prevalence and clinical features of peripheral ... more The purpose of this study was to characterize the prevalence and clinical features of peripheral arterial disease (PAD) among 90-year-old individuals and to assess its relationship to lower extremity functional status and survival over one year. A prospective, population- based study of all 90-year-old residents of Jyväskylä, Finland. Fifty-eight out of the 79 registered residents were examined for ankle-brachial index (ABI). Lower extremity functional status was assessed as self-reported difficulty in performing specific physical activities of daily living (PADL). In a subgroup of 36 individuals, lower extremity functioning was further assessed by measuring walking endurance and walking velocity. Death dates were collected for one year after the examination from the hospital register. Thirteen persons (22%) had an ABI<0.9. PAD was asymptomatic in 11 of them and the diagnosis of PAD new to 12 of them. Thirty (52%) subjects had a normal ABI (0.9-1.4) and in 15 (26%) cases the ABI was pathologically high (>1.4). A significant accumulation of cardiovascular risk factors was observed among those with an ABI<0.9 compared with those with normal or high ABI (2.0+/-0.8 vs 1.3+/-0.8 vs 1.5+/-0.5, p=0.03). Those with low or high ABI reported more difficulties in the PADL tasks than those with normal ABI, but the results did not reach statistical significance. No difference in maximal walking velocity was observed according to ABI in the subgroup with data available. After one year, nine people had died, of whom only two (7%) with normal ABI and seven with low or high ABI (25%) (p=0.05). PAD was found to be mainly asymptomatic among 90-year-old people. An abnormal ABI was also associated with increased mortality risk over a one-year follow-up. Although our study was small-scale, it does provide novel information about the prevalence of PAD and clinical significance of ABI in very old people.
European Journal of Vascular and Endovascular Surgery, 2008
Objectives. To assess the prevalence and clinical significance of elevated ankle-brachial index (... more Objectives. To assess the prevalence and clinical significance of elevated ankle-brachial index (ABI) in patients referred to vascular consultation. Design. Retrospective clinical study. Material and methods. In 1,762 patients referred with a suspicion of peripheral arterial disease (PAD), ABI and toe brachial index (TBI) were measured by photoplethysmography. ABI ! 1.3 was considered falsely elevated and TBI < 0.60 was the diagnostic criterion for PAD. Results. The prevalence of elevated ABI was 8.4% and that of PAD among these patients 62.2%. PAD was significantly more prevalent among subjects with severe symptoms (rest pain, ulcers or gangrene) than in those with intermittent claudication (83.8% and 45.3%, respectively, p < 0.001). The risk of PAD diagnosis was ten-fold (OR 10.31, 95% CI 2.07e51.30) among those with chronic renal failure, five-fold among patients with a history of smoking (OR 5.63, 95% CI 1.22e26.00) and over three-fold (OR 3.44, 95% CI 1.46e8.12) among those with coronary heart disease. The specificities of elevated ABI threshold levels (1.3, 1.4 and 1.5) in identifying PAD were 86%, 94% and 96%, respectively, the sensitivities being 44%, 38% and 36%, respectively. Conclusions. The prevalence of elevated ABI in patients referred to vascular consultation is 8.4% and that of PAD among these 62.2%. PAD is significantly more probable among those with chronic renal failure, a history of smoking and coronary heart disease. Furthermore, the specificity of elevated ABI (!1.3) in recognizing PAD is good, whereas the sensitivity is only satisfactory. Ó
Prosthetics and Orthotics International, 2007
The purpose of the study was to evaluate possible differences between genders in amputation incid... more The purpose of the study was to evaluate possible differences between genders in amputation incidence, revascularization activity before and survival after amputation. This population-based study was carried out in a well-defined geographical area, where all vascular surgical consultations and reconstructions are performed in one university hospital. All amputations performed in the region during 1990 - 1999 were identified from the hospital central registers. According to patient's identity codes, the Cause of Death Registry of Statistics Finland provided death data. Amputation data were cross-linked with the local vascular registry using identity codes. Women were found to be 8 years older than men (p < 0.0001). Major amputations comprised 73.4% in males and 77.7% in females. The age-standardized amputation incidence among males was 338 and among females 226 (per 10(6) inhabitants/year) (p < 0.001). The most prominent difference was seen in amputations due to trauma, where the age-adjusted major amputation incidence was over three-fold among males compared to females. The proportion of patients who had undergone vascular procedure before amputation was 23% in both genders. Median survival after amputation was 943 days in men and 716 in women (p = 0.01). When the higher age of women was considered, there was no significant difference between the genders. Survival was poorer among diabetics in both genders and the difference was significant in males. The amputation incidence was found to be higher in men compared to women in all etiologic subgroups except malignant tumour. Almost one in 4 patients had undergone vascular surgical reconstruction before amputation in both genders. There was no significant difference between the genders in survival after amputation. Subjects with diabetes had a poorer survival after major amputation than those without diabetes.
…, 2003
... J Saarinen*, M Heikkinen*, V Suominen*, J Virkkunen*, R Zeitlin*, K Rasku, R Saaristo*, J V... more ... J Saarinen*, M Heikkinen*, V Suominen*, J Virkkunen*, R Zeitlin*, K Rasku, R Saaristo*, J Vainio, I Nordback* and JP Salenius* *Department of ... Eur J Vasc Endovasc Surg 2001; 21: 35360 10 Guex JJ, Hiltbrand B, Bayon JM, Henri F, Allaert FA, Perrin M. Anatomical ...
Scandinavian journal of surgery : SJS : official organ for the Finnish Surgical Society and the Scandinavian Surgical Society, 2003
Autogenous fistula should be constructed in a minimum of 50% of all new ESRD patients scheduled f... more Autogenous fistula should be constructed in a minimum of 50% of all new ESRD patients scheduled for haemodialysis. The radio-cephalic fistula described by Brescia and colleagues in 1966 is considered to be the access of choice due to its good patency and low complication rate. The aim of this study was to evaluate the outcome of primary access surgery in a well-defined geographical region in Finland. All primary vascular access procedures between 1990-1999 were selected in the local vascular registry. Additional data was collected from patients' case records. Kaplan-Meier method was used to calculate fistula patency. Multivariate analysis of four variables (age, gender, diabetes mellitus, smoking) was done to determine their association with primary success 407 primary procedures were done during the 10-year period including 405 (99.5%) autogenous fistulas and two prosthetic grafts (0.5%). 230 (56.8%) fistulas were used for haemodialysis during the study. Cumulative primary func...
Acta chirurgica Belgica
Background and aims : The purpose of this prospective clinical study was to evaluate the reliabil... more Background and aims : The purpose of this prospective clinical study was to evaluate the reliability and adequacy of preoperative physical examination in determining the quality of vessels prior to primary vascular access procedure by performing peroperative completion fistulography. Material and methods : 26 consecutive patients who were scheduled for primary vascular access surgery, between July 2001 and June 2002, were included. Findings between the preoperative physical examination and peroperative completion fistulography were compared. Results : Of the 26 patients that were initially enrolled in the study, 4 patients were excluded because physical examination showed poor superficial arm veins and 2 patients had not undergone access procedure by the end of the study. The remaining twenty patients constituted the actual study group. The arteriovenous fistula could be performed at the chosen level and way in all 20 patients. The findings between preoperative physical examination and peroperative fistulography were compatible and the specificity of physical examination to detect patent inflow and outflow vessels was 100%. Due to the fact that 4 patients in whom a poor vein was suspected were excluded, the sensitivity could not be assessed. Conclusions : Preoperative physical examination seems to be reliable and adequate method in determining vessel quality prior primary vascular access surgery. According to our study, its specificity is high in determining patent inflow and outflow vessels. However, because of exclusion of patients with suspected problem, sensitivity cannot be determined.
Scandinavian journal of surgery: SJS: official organ for the Finnish Surgical Society and the Scandinavian Surgical Society
With any new technology complications are possible, and problems with first-generation aortic ste... more With any new technology complications are possible, and problems with first-generation aortic stentgrafts have been extensively reported. The longterm outcome of this patient population and the magnitude of additional secondary procedures are, however, less well covered. Between February 1997 and November 1999, 48 patients (44 men and 4 women; mean age 70 years; range 54-85) with AAA (average 57mm, range 40-90mm) were treated with a Vanguard endoprosthesis. Stentgrafts were sized by CT and angiography-based measurements. Results were continuously assessed using contrast-enhanced CT before discharge, 1, 3, 6 and 12 months after the procedure and thereafter annually. Since 2001 plain abdominal X-rays have been performed annually. The technical implant success rate was 100%. Median follow-up was 91 months (range 7.6-120 months). None of the patients was lost during this period. Hospital mortality was 0%. There were 25 subsequent deaths (52%), the most common cause being coronary artery...
Scandinavian journal of surgery : SJS : official organ for the Finnish Surgical Society and the Scandinavian Surgical Society, 2003
Autogenous fistula should be constructed in a minimum of 50% of all new ESRD patients scheduled f... more Autogenous fistula should be constructed in a minimum of 50% of all new ESRD patients scheduled for haemodialysis. The radio-cephalic fistula described by Brescia and colleagues in 1966 is considered to be the access of choice due to its good patency and low complication rate. The aim of this study was to evaluate the outcome of primary access surgery in a well-defined geographical region in Finland. All primary vascular access procedures between 1990-1999 were selected in the local vascular registry. Additional data was collected from patients' case records. Kaplan-Meier method was used to calculate fistula patency. Multivariate analysis of four variables (age, gender, diabetes mellitus, smoking) was done to determine their association with primary success 407 primary procedures were done during the 10-year period including 405 (99.5%) autogenous fistulas and two prosthetic grafts (0.5%). 230 (56.8%) fistulas were used for haemodialysis during the study. Cumulative primary func...
Scandinavian journal of surgery : SJS : official organ for the Finnish Surgical Society and the Scandinavian Surgical Society, 2005
It is difficult to assess the severity and location of venous insufficiency in legs with recurren... more It is difficult to assess the severity and location of venous insufficiency in legs with recurrent varicose disease. This present purpose was to evaluate the distribution of reflux and the diagnostic role of current classifications in a consecutive series of legs with previously operated varicose disease. A total of 90 legs in a cohort of 66 patients were included. The examination comprised CEAP clinical class, clinical disability score (CDS) and leg symptoms. Colour-flow duplex imaging (CFDI) was used to observe reflux in deep and superficial veins. Details of prior surgery were assessed. The site of superficial reflux was at the groin in 58% (recurrent or residive vein trunk or unoperated great saphenous vein), and the rate in the popliteal fossa was 11% (unoperated short saphenous vein). In 58% of the legs presenting superficial reflux at groin level, previous surgery at the saphenofemoral junction was noted. A sensation of pain was observed in 74% of the legs, sensation of oedem...
Scandinavian journal of surgery : SJS : official organ for the Finnish Surgical Society and the Scandinavian Surgical Society, 2002
The ideal treatment of abdominal aortic aneurysms (AAA) is to operate aneurysms likely to rupture... more The ideal treatment of abdominal aortic aneurysms (AAA) is to operate aneurysms likely to rupture, without exposing other cases to major surgery. The purpose here was to analyse retrospectively the management of AAA in a well-defined geographical region in the 1990's. 194 new vascular surgical outpatient consultations due to AAA were done to the regional vascular centre during the years 1990, 1992, 1994, 1996 and 1998. Data were collected from case records. Statistics Finland provided causes and dates of death. The mean observed annual AAA incidence was 9.0 per 100 000 inhabitants and it rose significantly (33.3%) during the study period. The duration of follow-up varied between 0 and 129 months. The 5/8-year cumulative mortality was 37.3/50.7%. The most common causes of death were AAA-related (31.7%), cardiac (29.1%) or malignancy (19.0%). Twenty-five patients with small AAA were referred to primary health care sector for further follow-up. There were no RAAA (ruptured AAA) dea...
…, 2003
... J Saarinen*, M Heikkinen*, V Suominen*, J Virkkunen*, R Zeitlin*, K Rasku, R Saaristo*, J V... more ... J Saarinen*, M Heikkinen*, V Suominen*, J Virkkunen*, R Zeitlin*, K Rasku, R Saaristo*, J Vainio, I Nordback* and JP Salenius* *Department of ... Eur J Vasc Endovasc Surg 2001; 21: 35360 10 Guex JJ, Hiltbrand B, Bayon JM, Henri F, Allaert FA, Perrin M. Anatomical ...
The European journal of surgery = Acta chirurgica, 2002
To evaluate regional differences in the use of a vascular surgical service in the treatment of cr... more To evaluate regional differences in the use of a vascular surgical service in the treatment of critical lower limb ischaemia and incidence of amputation in the 1990s in a well-defined geographical area. Retrospective study. One university and five county hospitals, Finland. All referrals to the university hospital vascular surgical unit for chronic critical lower limb ischaemia and the number of major amputations in the region. Numbers of new vascular surgical consultations and amputations in 11 municipalities. Correlation between numbers of consultations and amputations. Between the subregions the age-standardised incidence of new vascular surgical consultations in the 15-85 year old population varied from 52.4 to 104.7/10(5) and the incidence of amputation from 10.2 to 24.8/10(5). There was an inverse correlation between the numbers of consultations and amputations. The most significant inverse correlation was between consultations and below knee amputations in diabetic patients (...
Acta chirurgica Belgica
The purpose of this study was to analyze retrospectively the treatment of patients referred for c... more The purpose of this study was to analyze retrospectively the treatment of patients referred for carotid artery stenosis to a vascular surgical unit in the 1990's. Main attention was paid to the appropriateness of the indications for CEA. In the Pirkanmaa region (population of 440 000), all carotid surgery is performed in the regional University Hospital. All new referrals for vascular surgery because of carotid stenosis or bruit in 1990, 1992, 1994, 1996 and 1998 were included and case records reviewed. Four hundred patients were referred. Indication for referral was a neurologic event in 46.2%, indefinite symptom in 27.9% and asymptomatic stenosis or carotid bruit in 25.9%. Most patients underwent carotid ultrasound as first imaging (93.7%). Almost half of the patients were operated (n=176). The 30-day combined stroke and death rate was 6.5%. Appropriate indication for CEA was found in 31.6%. Over half (57.0%) of the indications were considered uncertain and 11.4% inappropriate...
Scandinavian journal of surgery : SJS : official organ for the Finnish Surgical Society and the Scandinavian Surgical Society, 2002
The ideal treatment of abdominal aortic aneurysms (AAA) is to operate aneurysms likely to rupture... more The ideal treatment of abdominal aortic aneurysms (AAA) is to operate aneurysms likely to rupture, without exposing other cases to major surgery. The purpose here was to analyse retrospectively the management of AAA in a well-defined geographical region in the 1990's. 194 new vascular surgical outpatient consultations due to AAA were done to the regional vascular centre during the years 1990, 1992, 1994, 1996 and 1998. Data were collected from case records. Statistics Finland provided causes and dates of death. The mean observed annual AAA incidence was 9.0 per 100 000 inhabitants and it rose significantly (33.3%) during the study period. The duration of follow-up varied between 0 and 129 months. The 5/8-year cumulative mortality was 37.3/50.7%. The most common causes of death were AAA-related (31.7%), cardiac (29.1%) or malignancy (19.0%). Twenty-five patients with small AAA were referred to primary health care sector for further follow-up. There were no RAAA (ruptured AAA) dea...
Scandinavian journal of surgery: SJS: official organ for the Finnish Surgical Society and the Scandinavian Surgical Society
With any new technology complications are possible, and problems with first-generation aortic ste... more With any new technology complications are possible, and problems with first-generation aortic stentgrafts have been extensively reported. The longterm outcome of this patient population and the magnitude of additional secondary procedures are, however, less well covered. Between February 1997 and November 1999, 48 patients (44 men and 4 women; mean age 70 years; range 54-85) with AAA (average 57mm, range 40-90mm) were treated with a Vanguard endoprosthesis. Stentgrafts were sized by CT and angiography-based measurements. Results were continuously assessed using contrast-enhanced CT before discharge, 1, 3, 6 and 12 months after the procedure and thereafter annually. Since 2001 plain abdominal X-rays have been performed annually. The technical implant success rate was 100%. Median follow-up was 91 months (range 7.6-120 months). None of the patients was lost during this period. Hospital mortality was 0%. There were 25 subsequent deaths (52%), the most common cause being coronary artery...
PLoS ONE, 2012
Background: Atherosclerosis is a complex disease with hundreds of genes influencing its progressi... more Background: Atherosclerosis is a complex disease with hundreds of genes influencing its progression. In addition, the phenotype of the disease varies significantly depending on the arterial bed.
The primary objective of aneurysm repair is to prevent aneurysm rupture while avoiding aneurysm-r... more The primary objective of aneurysm repair is to prevent aneurysm rupture while avoiding aneurysm-related death. This manuscript reviews the primary and secondary outcome measures following endovascular aneurysm repair (EVAR) in relation to similar outcome measures for open surgical repair. Both EVAR and open repair are effective in preventing aneurysm rupture, although late ruptures can occur with either treatment method. The late risk of rupture following EVAR is less that 1% per year using current endovascular devices. Aneurysm-related death rate appears to be lower following EVAR compared to open surgery, primarily due to a lower perioperative mortality rate. Actuarial 5-year survival after both endovascular and open aneurysm repair is approximately 70%. Perioperative outcome measures favor EVAR over open repair for patients with suitable anatomy with reduced morbidity and more rapid patient recovery. Short and long-term outcomes following endovascular repair compare favorably to open repair. However, prospective studies are needed to better define the long-term outcomes using comparable endpoints.
Scandinavian journal of surgery : SJS : official organ for the Finnish Surgical Society and the Scandinavian Surgical Society, 2005
It is difficult to assess the severity and location of venous insufficiency in legs with recurren... more It is difficult to assess the severity and location of venous insufficiency in legs with recurrent varicose disease. This present purpose was to evaluate the distribution of reflux and the diagnostic role of current classifications in a consecutive series of legs with previously operated varicose disease. A total of 90 legs in a cohort of 66 patients were included. The examination comprised CEAP clinical class, clinical disability score (CDS) and leg symptoms. Colour-flow duplex imaging (CFDI) was used to observe reflux in deep and superficial veins. Details of prior surgery were assessed. The site of superficial reflux was at the groin in 58% (recurrent or residive vein trunk or unoperated great saphenous vein), and the rate in the popliteal fossa was 11% (unoperated short saphenous vein). In 58% of the legs presenting superficial reflux at groin level, previous surgery at the saphenofemoral junction was noted. A sensation of pain was observed in 74% of the legs, sensation of oedem...
European Journal of Vascular and Endovascular Surgery, 2010
Objective: This study aims to evaluate mortality across ankle-brachial index (ABI) values and to ... more Objective: This study aims to evaluate mortality across ankle-brachial index (ABI) values and to assess the association between elevated ABI, peripheral arterial disease (PAD) and mortality.
Aging Clinical and Experimental Research, 2008
The purpose of this study was to characterize the prevalence and clinical features of peripheral ... more The purpose of this study was to characterize the prevalence and clinical features of peripheral arterial disease (PAD) among 90-year-old individuals and to assess its relationship to lower extremity functional status and survival over one year. A prospective, population- based study of all 90-year-old residents of Jyväskylä, Finland. Fifty-eight out of the 79 registered residents were examined for ankle-brachial index (ABI). Lower extremity functional status was assessed as self-reported difficulty in performing specific physical activities of daily living (PADL). In a subgroup of 36 individuals, lower extremity functioning was further assessed by measuring walking endurance and walking velocity. Death dates were collected for one year after the examination from the hospital register. Thirteen persons (22%) had an ABI&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.9. PAD was asymptomatic in 11 of them and the diagnosis of PAD new to 12 of them. Thirty (52%) subjects had a normal ABI (0.9-1.4) and in 15 (26%) cases the ABI was pathologically high (&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;1.4). A significant accumulation of cardiovascular risk factors was observed among those with an ABI&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.9 compared with those with normal or high ABI (2.0+/-0.8 vs 1.3+/-0.8 vs 1.5+/-0.5, p=0.03). Those with low or high ABI reported more difficulties in the PADL tasks than those with normal ABI, but the results did not reach statistical significance. No difference in maximal walking velocity was observed according to ABI in the subgroup with data available. After one year, nine people had died, of whom only two (7%) with normal ABI and seven with low or high ABI (25%) (p=0.05). PAD was found to be mainly asymptomatic among 90-year-old people. An abnormal ABI was also associated with increased mortality risk over a one-year follow-up. Although our study was small-scale, it does provide novel information about the prevalence of PAD and clinical significance of ABI in very old people.
European Journal of Vascular and Endovascular Surgery, 2008
Objectives. To assess the prevalence and clinical significance of elevated ankle-brachial index (... more Objectives. To assess the prevalence and clinical significance of elevated ankle-brachial index (ABI) in patients referred to vascular consultation. Design. Retrospective clinical study. Material and methods. In 1,762 patients referred with a suspicion of peripheral arterial disease (PAD), ABI and toe brachial index (TBI) were measured by photoplethysmography. ABI ! 1.3 was considered falsely elevated and TBI < 0.60 was the diagnostic criterion for PAD. Results. The prevalence of elevated ABI was 8.4% and that of PAD among these patients 62.2%. PAD was significantly more prevalent among subjects with severe symptoms (rest pain, ulcers or gangrene) than in those with intermittent claudication (83.8% and 45.3%, respectively, p < 0.001). The risk of PAD diagnosis was ten-fold (OR 10.31, 95% CI 2.07e51.30) among those with chronic renal failure, five-fold among patients with a history of smoking (OR 5.63, 95% CI 1.22e26.00) and over three-fold (OR 3.44, 95% CI 1.46e8.12) among those with coronary heart disease. The specificities of elevated ABI threshold levels (1.3, 1.4 and 1.5) in identifying PAD were 86%, 94% and 96%, respectively, the sensitivities being 44%, 38% and 36%, respectively. Conclusions. The prevalence of elevated ABI in patients referred to vascular consultation is 8.4% and that of PAD among these 62.2%. PAD is significantly more probable among those with chronic renal failure, a history of smoking and coronary heart disease. Furthermore, the specificity of elevated ABI (!1.3) in recognizing PAD is good, whereas the sensitivity is only satisfactory. Ó
Prosthetics and Orthotics International, 2007
The purpose of the study was to evaluate possible differences between genders in amputation incid... more The purpose of the study was to evaluate possible differences between genders in amputation incidence, revascularization activity before and survival after amputation. This population-based study was carried out in a well-defined geographical area, where all vascular surgical consultations and reconstructions are performed in one university hospital. All amputations performed in the region during 1990 - 1999 were identified from the hospital central registers. According to patient's identity codes, the Cause of Death Registry of Statistics Finland provided death data. Amputation data were cross-linked with the local vascular registry using identity codes. Women were found to be 8 years older than men (p < 0.0001). Major amputations comprised 73.4% in males and 77.7% in females. The age-standardized amputation incidence among males was 338 and among females 226 (per 10(6) inhabitants/year) (p < 0.001). The most prominent difference was seen in amputations due to trauma, where the age-adjusted major amputation incidence was over three-fold among males compared to females. The proportion of patients who had undergone vascular procedure before amputation was 23% in both genders. Median survival after amputation was 943 days in men and 716 in women (p = 0.01). When the higher age of women was considered, there was no significant difference between the genders. Survival was poorer among diabetics in both genders and the difference was significant in males. The amputation incidence was found to be higher in men compared to women in all etiologic subgroups except malignant tumour. Almost one in 4 patients had undergone vascular surgical reconstruction before amputation in both genders. There was no significant difference between the genders in survival after amputation. Subjects with diabetes had a poorer survival after major amputation than those without diabetes.
…, 2003
... J Saarinen*, M Heikkinen*, V Suominen*, J Virkkunen*, R Zeitlin*, K Rasku, R Saaristo*, J V... more ... J Saarinen*, M Heikkinen*, V Suominen*, J Virkkunen*, R Zeitlin*, K Rasku, R Saaristo*, J Vainio, I Nordback* and JP Salenius* *Department of ... Eur J Vasc Endovasc Surg 2001; 21: 35360 10 Guex JJ, Hiltbrand B, Bayon JM, Henri F, Allaert FA, Perrin M. Anatomical ...
Scandinavian journal of surgery : SJS : official organ for the Finnish Surgical Society and the Scandinavian Surgical Society, 2003
Autogenous fistula should be constructed in a minimum of 50% of all new ESRD patients scheduled f... more Autogenous fistula should be constructed in a minimum of 50% of all new ESRD patients scheduled for haemodialysis. The radio-cephalic fistula described by Brescia and colleagues in 1966 is considered to be the access of choice due to its good patency and low complication rate. The aim of this study was to evaluate the outcome of primary access surgery in a well-defined geographical region in Finland. All primary vascular access procedures between 1990-1999 were selected in the local vascular registry. Additional data was collected from patients' case records. Kaplan-Meier method was used to calculate fistula patency. Multivariate analysis of four variables (age, gender, diabetes mellitus, smoking) was done to determine their association with primary success 407 primary procedures were done during the 10-year period including 405 (99.5%) autogenous fistulas and two prosthetic grafts (0.5%). 230 (56.8%) fistulas were used for haemodialysis during the study. Cumulative primary func...
Acta chirurgica Belgica
Background and aims : The purpose of this prospective clinical study was to evaluate the reliabil... more Background and aims : The purpose of this prospective clinical study was to evaluate the reliability and adequacy of preoperative physical examination in determining the quality of vessels prior to primary vascular access procedure by performing peroperative completion fistulography. Material and methods : 26 consecutive patients who were scheduled for primary vascular access surgery, between July 2001 and June 2002, were included. Findings between the preoperative physical examination and peroperative completion fistulography were compared. Results : Of the 26 patients that were initially enrolled in the study, 4 patients were excluded because physical examination showed poor superficial arm veins and 2 patients had not undergone access procedure by the end of the study. The remaining twenty patients constituted the actual study group. The arteriovenous fistula could be performed at the chosen level and way in all 20 patients. The findings between preoperative physical examination and peroperative fistulography were compatible and the specificity of physical examination to detect patent inflow and outflow vessels was 100%. Due to the fact that 4 patients in whom a poor vein was suspected were excluded, the sensitivity could not be assessed. Conclusions : Preoperative physical examination seems to be reliable and adequate method in determining vessel quality prior primary vascular access surgery. According to our study, its specificity is high in determining patent inflow and outflow vessels. However, because of exclusion of patients with suspected problem, sensitivity cannot be determined.
Scandinavian journal of surgery: SJS: official organ for the Finnish Surgical Society and the Scandinavian Surgical Society
With any new technology complications are possible, and problems with first-generation aortic ste... more With any new technology complications are possible, and problems with first-generation aortic stentgrafts have been extensively reported. The longterm outcome of this patient population and the magnitude of additional secondary procedures are, however, less well covered. Between February 1997 and November 1999, 48 patients (44 men and 4 women; mean age 70 years; range 54-85) with AAA (average 57mm, range 40-90mm) were treated with a Vanguard endoprosthesis. Stentgrafts were sized by CT and angiography-based measurements. Results were continuously assessed using contrast-enhanced CT before discharge, 1, 3, 6 and 12 months after the procedure and thereafter annually. Since 2001 plain abdominal X-rays have been performed annually. The technical implant success rate was 100%. Median follow-up was 91 months (range 7.6-120 months). None of the patients was lost during this period. Hospital mortality was 0%. There were 25 subsequent deaths (52%), the most common cause being coronary artery...
Scandinavian journal of surgery : SJS : official organ for the Finnish Surgical Society and the Scandinavian Surgical Society, 2003
Autogenous fistula should be constructed in a minimum of 50% of all new ESRD patients scheduled f... more Autogenous fistula should be constructed in a minimum of 50% of all new ESRD patients scheduled for haemodialysis. The radio-cephalic fistula described by Brescia and colleagues in 1966 is considered to be the access of choice due to its good patency and low complication rate. The aim of this study was to evaluate the outcome of primary access surgery in a well-defined geographical region in Finland. All primary vascular access procedures between 1990-1999 were selected in the local vascular registry. Additional data was collected from patients' case records. Kaplan-Meier method was used to calculate fistula patency. Multivariate analysis of four variables (age, gender, diabetes mellitus, smoking) was done to determine their association with primary success 407 primary procedures were done during the 10-year period including 405 (99.5%) autogenous fistulas and two prosthetic grafts (0.5%). 230 (56.8%) fistulas were used for haemodialysis during the study. Cumulative primary func...
Scandinavian journal of surgery : SJS : official organ for the Finnish Surgical Society and the Scandinavian Surgical Society, 2005
It is difficult to assess the severity and location of venous insufficiency in legs with recurren... more It is difficult to assess the severity and location of venous insufficiency in legs with recurrent varicose disease. This present purpose was to evaluate the distribution of reflux and the diagnostic role of current classifications in a consecutive series of legs with previously operated varicose disease. A total of 90 legs in a cohort of 66 patients were included. The examination comprised CEAP clinical class, clinical disability score (CDS) and leg symptoms. Colour-flow duplex imaging (CFDI) was used to observe reflux in deep and superficial veins. Details of prior surgery were assessed. The site of superficial reflux was at the groin in 58% (recurrent or residive vein trunk or unoperated great saphenous vein), and the rate in the popliteal fossa was 11% (unoperated short saphenous vein). In 58% of the legs presenting superficial reflux at groin level, previous surgery at the saphenofemoral junction was noted. A sensation of pain was observed in 74% of the legs, sensation of oedem...
Scandinavian journal of surgery : SJS : official organ for the Finnish Surgical Society and the Scandinavian Surgical Society, 2002
The ideal treatment of abdominal aortic aneurysms (AAA) is to operate aneurysms likely to rupture... more The ideal treatment of abdominal aortic aneurysms (AAA) is to operate aneurysms likely to rupture, without exposing other cases to major surgery. The purpose here was to analyse retrospectively the management of AAA in a well-defined geographical region in the 1990's. 194 new vascular surgical outpatient consultations due to AAA were done to the regional vascular centre during the years 1990, 1992, 1994, 1996 and 1998. Data were collected from case records. Statistics Finland provided causes and dates of death. The mean observed annual AAA incidence was 9.0 per 100 000 inhabitants and it rose significantly (33.3%) during the study period. The duration of follow-up varied between 0 and 129 months. The 5/8-year cumulative mortality was 37.3/50.7%. The most common causes of death were AAA-related (31.7%), cardiac (29.1%) or malignancy (19.0%). Twenty-five patients with small AAA were referred to primary health care sector for further follow-up. There were no RAAA (ruptured AAA) dea...
…, 2003
... J Saarinen*, M Heikkinen*, V Suominen*, J Virkkunen*, R Zeitlin*, K Rasku, R Saaristo*, J V... more ... J Saarinen*, M Heikkinen*, V Suominen*, J Virkkunen*, R Zeitlin*, K Rasku, R Saaristo*, J Vainio, I Nordback* and JP Salenius* *Department of ... Eur J Vasc Endovasc Surg 2001; 21: 35360 10 Guex JJ, Hiltbrand B, Bayon JM, Henri F, Allaert FA, Perrin M. Anatomical ...
The European journal of surgery = Acta chirurgica, 2002
To evaluate regional differences in the use of a vascular surgical service in the treatment of cr... more To evaluate regional differences in the use of a vascular surgical service in the treatment of critical lower limb ischaemia and incidence of amputation in the 1990s in a well-defined geographical area. Retrospective study. One university and five county hospitals, Finland. All referrals to the university hospital vascular surgical unit for chronic critical lower limb ischaemia and the number of major amputations in the region. Numbers of new vascular surgical consultations and amputations in 11 municipalities. Correlation between numbers of consultations and amputations. Between the subregions the age-standardised incidence of new vascular surgical consultations in the 15-85 year old population varied from 52.4 to 104.7/10(5) and the incidence of amputation from 10.2 to 24.8/10(5). There was an inverse correlation between the numbers of consultations and amputations. The most significant inverse correlation was between consultations and below knee amputations in diabetic patients (...
Acta chirurgica Belgica
The purpose of this study was to analyze retrospectively the treatment of patients referred for c... more The purpose of this study was to analyze retrospectively the treatment of patients referred for carotid artery stenosis to a vascular surgical unit in the 1990's. Main attention was paid to the appropriateness of the indications for CEA. In the Pirkanmaa region (population of 440 000), all carotid surgery is performed in the regional University Hospital. All new referrals for vascular surgery because of carotid stenosis or bruit in 1990, 1992, 1994, 1996 and 1998 were included and case records reviewed. Four hundred patients were referred. Indication for referral was a neurologic event in 46.2%, indefinite symptom in 27.9% and asymptomatic stenosis or carotid bruit in 25.9%. Most patients underwent carotid ultrasound as first imaging (93.7%). Almost half of the patients were operated (n=176). The 30-day combined stroke and death rate was 6.5%. Appropriate indication for CEA was found in 31.6%. Over half (57.0%) of the indications were considered uncertain and 11.4% inappropriate...
Scandinavian journal of surgery : SJS : official organ for the Finnish Surgical Society and the Scandinavian Surgical Society, 2002
The ideal treatment of abdominal aortic aneurysms (AAA) is to operate aneurysms likely to rupture... more The ideal treatment of abdominal aortic aneurysms (AAA) is to operate aneurysms likely to rupture, without exposing other cases to major surgery. The purpose here was to analyse retrospectively the management of AAA in a well-defined geographical region in the 1990's. 194 new vascular surgical outpatient consultations due to AAA were done to the regional vascular centre during the years 1990, 1992, 1994, 1996 and 1998. Data were collected from case records. Statistics Finland provided causes and dates of death. The mean observed annual AAA incidence was 9.0 per 100 000 inhabitants and it rose significantly (33.3%) during the study period. The duration of follow-up varied between 0 and 129 months. The 5/8-year cumulative mortality was 37.3/50.7%. The most common causes of death were AAA-related (31.7%), cardiac (29.1%) or malignancy (19.0%). Twenty-five patients with small AAA were referred to primary health care sector for further follow-up. There were no RAAA (ruptured AAA) dea...
Scandinavian journal of surgery: SJS: official organ for the Finnish Surgical Society and the Scandinavian Surgical Society
With any new technology complications are possible, and problems with first-generation aortic ste... more With any new technology complications are possible, and problems with first-generation aortic stentgrafts have been extensively reported. The longterm outcome of this patient population and the magnitude of additional secondary procedures are, however, less well covered. Between February 1997 and November 1999, 48 patients (44 men and 4 women; mean age 70 years; range 54-85) with AAA (average 57mm, range 40-90mm) were treated with a Vanguard endoprosthesis. Stentgrafts were sized by CT and angiography-based measurements. Results were continuously assessed using contrast-enhanced CT before discharge, 1, 3, 6 and 12 months after the procedure and thereafter annually. Since 2001 plain abdominal X-rays have been performed annually. The technical implant success rate was 100%. Median follow-up was 91 months (range 7.6-120 months). None of the patients was lost during this period. Hospital mortality was 0%. There were 25 subsequent deaths (52%), the most common cause being coronary artery...
PLoS ONE, 2012
Background: Atherosclerosis is a complex disease with hundreds of genes influencing its progressi... more Background: Atherosclerosis is a complex disease with hundreds of genes influencing its progression. In addition, the phenotype of the disease varies significantly depending on the arterial bed.
The primary objective of aneurysm repair is to prevent aneurysm rupture while avoiding aneurysm-r... more The primary objective of aneurysm repair is to prevent aneurysm rupture while avoiding aneurysm-related death. This manuscript reviews the primary and secondary outcome measures following endovascular aneurysm repair (EVAR) in relation to similar outcome measures for open surgical repair. Both EVAR and open repair are effective in preventing aneurysm rupture, although late ruptures can occur with either treatment method. The late risk of rupture following EVAR is less that 1% per year using current endovascular devices. Aneurysm-related death rate appears to be lower following EVAR compared to open surgery, primarily due to a lower perioperative mortality rate. Actuarial 5-year survival after both endovascular and open aneurysm repair is approximately 70%. Perioperative outcome measures favor EVAR over open repair for patients with suitable anatomy with reduced morbidity and more rapid patient recovery. Short and long-term outcomes following endovascular repair compare favorably to open repair. However, prospective studies are needed to better define the long-term outcomes using comparable endpoints.