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Objectives. A high frequency of asymptomatic pulmonary embolism (PE) in patients with deep venous thrombosis (DVT) has been reported, but information about the outcome of the patients with PE remains sparse. The aims of the present study were to assess the prevalence of silent PE in patients with symptomatic, venographically proven DVT, and to evaluate the natural history of silent PE. Design. Consecutive patients from one centre of primary care were included in a randomized, open study with blinded control. All patients gave written, informed consent. Subjects. Eighty-seven consecutive patients with venographically proven DVT and with a perfusionventilation lung scintigraphy performed within 48 h of the DVT diagnosis were included. On the 10th and 60th days the lung scintigraphy was repeated in 80 and 60 patients, respectively. All the patients were followed for 3 months in the out-patient clinic. Interventions. All patients were ambulated from the first day and were allocated randomly to no anticoagulant (non-AC) therapy or to AC therapy with intravenous heparin infusion for at least 6 days and oral AC therapy for 3 months. Results. Forty-three of these patients had a high probability lung scintigraphy for PE. Distal vein and femoral vein thrombosis embolized in 33 and 53% of patients, respectively. The progression rate after 60 days was 3% in both the AC and the non-AC group and after 10 days the rates were 13 and 8%, respectively. Conclusions. A high frequency of silent PE in patients with DVT both above and below the knee is demonstrated. AC treatment did not influence the resolution rate of PE or the rate of clinical PE in a 3-month follow-up period.

INTRODUCTION: Screening and observation of abdominal aortic aneurysms (AAA) produce psychological stress. Consequently, safe and optimal intervals of rescreening and observation must be developed. METHOD: In a randomised, mass screening trial of 6,339 men aged, 65-73 years from 1994 to 1998, 76% attended, and 191 (4%) had AAA > or = 3 cm. Twenty-four (0.5%) had AAA above 5 cm in diameter and were referred for surgery, while the rest were offered annual control. Later, all 348 (7.5%) men who, 3 to 5 years before, had had an ectatic aorta (an infrarenal aortic diameter of 25-29 mm or a distal/renal aortic diameter ratio of > 1.2) were offered rescreening, together with a control group of 380 men. RESULTS: None of the controls had developed AAA. Of those who initially had an aortic diameter of 25-29 mm aorta, 28.5% had developed AAA (size range 30-48 mm), whereas only 3.5% with a ratio > 1.2 developed AAA (size range 30-34 mm). During the fourth year of surveillance some AAA initially sized below 3.5 cm expanded to above 5 cm, whereas this occurred in some sized 3.5-3.9 cm during the second year and in most above 4 cm did during the first year of observation. CONCLUSION: Rescreening for AAA can be restricted to initially ectatic aortas sized 25-29 mm at five-year intervals. Observation of small AAA can be restricted to 1-4 year intervals. Udgivelsesdato: 2001-Sep-10

The aim of the study was to compare the epidemiology, risk factors and manifestations of iliac and abdominal aortic aneurysm (AAA). Two studies were used: 1. Five thousand four hundred and seventy 65-73 year old men invited to screening for AAA. 2. Review of all 350 patients operated for central aneurysms in the county of Viborg in Denmark 1989-1997. Four thousand one hundred and seventy-six attended screening. One hundred and seventy (4.0%) had an AAA. Twenty-one (0.56%) required operation, while the prevalence of operation-requiring iliac aneurysm (IA) was 0.17%. The operative incidence of IA was 18.4 per mill. per year, and 92.4 per mill. per year were operated for AAA. Patients with IA had lower cholesterol-levels, and urological symptoms were present in 42% of cases with isolated IA, and 25% of combined aneurysms compared to 8% of isolated AAA (p0.05). Fifty-eight percent of the isolated IAs were ruptured, while only 27% of AAAs were ruptured (p0.05). The per- and postoperative mortality was 57% in ruptured isolated IA, 47% in ruptured combined aneurysms, and 31% in ruptured isolated AAA (p0.05). IA seems to be more under-diagnosed than AAA, and are often diagnosed because of clinical manifestations, especially urological or rupture. They seem more lethal in ruptured cases.

The aim of the study was to compare the epidemiology, risk factors and manifestations of iliac and abdominal aortic aneurysm (AAA). Two studies were used: 1. Five thousand four hundred and seventy 65-73 year old men invited to screening for AAA. 2. Review of all 350 patients operated for central aneurysms in the county of Viborg in Denmark 1989-1997. Four thousand one hundred and seventy-six attended screening. One hundred and seventy (4.0%) had an AAA. Twenty-one (0.56%) required operation, while the prevalence of operation-requiring iliac aneurysm (IA) was 0.17%. The operative incidence of IA was 18.4 per mill. per year, and 92.4 per mill. per year were operated for AAA. Patients with IA had lower cholesterol-levels, and urological symptoms were present in 42% of cases with isolated IA, and 25% of combined aneurysms compared to 8% of isolated AAA (p < 0.05). Fifty-eight percent of the isolated IAs were ruptured, while only 27% of AAAs were ruptured (p < 0.05). The per- and postoperative mortality was 57% in ruptured isolated IA, 47% in ruptured combined aneurysms, and 31% in ruptured isolated AAA (p < 0.05). IA seems to be more under-diagnosed than AAA, and are often diagnosed because of clinical manifestations, especially urological or rupture. They seem more lethal in ruptured cases. Udgivelsesdato: 2000-Aug-21

Udgivelsesdato: 1999-Mar BACKGROUND: To study the propranolol treatment of small abdominal aortic aneurysms (AAA) concerning intention to treat, side effects, and inhibition of expansion. METHODS: DESIGN: Two-year lasting prospective randomised double-blinded intervention trial. SETTING: Hospital-based mass screening for AAA with annual ambulatory control of small AAA. PARTICIPANTS: Of 122 screening-diagnosed small AAA, 51 (42%) were excluded because of contraindications or present beta-blockage, and 17 refused participation. Thus, 54 (44.3%) were included. INTERVENTION: Participants were randomised to 40 mg propranolol twice a day or placebo. MEASURES: The same observed was used to follow-up AAA-expansion, side effects, quality of life (QL), branchial and ankle blood pressure (ABI), and pulmonary function (FEV1 and FVC). RESULTS: Sixty percent in the propranolol group, and 25% in the placebo group dropped out, mainly caused by dyspnoea in the propranolol group (RR=1.74, 95% C.I.: 1.06-2.86). Five (16.7%) died in the propranolol group, while 1 (4.2%) died in the placebo group (RR=1.6 (1.02-2.51)). Furthermore, decreased pulmonary function, ABI, and QL was noticed in the propranolol group. Consequently, the trial was stopped after two years. Ninety-five percent of the measurements of the AAA were measured within 2 mm variation. If expansion was defined as above 2 mm annually, the relative risk of expansion in the placebo group was 1.17 (0.74-1.85), and 2.44 (0.88-6.77) among the non-drop-outs. CONCLUSIONS: Only 22% of small screenings-diagnosed AAA were treatable with propranolol for two years. Consequently, only large scale studies are capable of showing potential minor inhibition of expansion by propranolol. However, whether such treatment ever becomes ethically acceptable is debatable.

The objective of the study was to compare emergency operations for ruptured abdominal aortic aneurysm (RAAA) by a mobile operation team, with operation for RAAA carried out at our vascular unit. During a five year period (1993-1998), 18 emergency operations were carried out for abdominal aortic aneurysm (AAA) with rupture at the primary receiving hospital with assistance from a mobile operation team. In the same period 82 aneurysms with rupture were resected at our vascular surgical unit. Preoperatively, patients operated at the primary receiving hospitals had significantly lower blood pressure (P < 0.05) and an intraoperative higher blood loss (P < 0.05). Furthermore, postoperative complications tended to be higher among patients operated at hospitals without a vascular unit. consequently, the mortality was 67% compared to 47% in the department. However, 1/3 of the patients operated by the mobile operation team survived. Consequently, haemodynamically unstable non-transportable patients with an RAAA should be considered for surgery by a mobile operation team. Udgivelsesdato: 1999-Aug-30

The relationship between abdominal aortic aneurysms (AAA) and chronical obstructive pulmonary disease (COPD), and in particular the suggested common elastin degradation caused by elastase and smoking was analysed by a cross sectional population mass screening study for AAA, and a prospective cohort study of small AAA. All previous computer-hospital-recorded diagnoses were received concerning 4,404 men invited to screening for AAA. One hundred and forty-one had AAA (4.2%). They were asked for an interview, a clinical examination, and a blood sample. Men with an AAA of 3-5 cm were offered annual control-scans to check for expansion. Of COPD-patients, 7.7% had AAA (crude OR = 2.05), however the adjusted OR was only 1.53 after adjusting for other co-existing diseases (p = 0.13). The mean annual expansion was 2.74 mm per year in COPD patients and 2.72 in non-COPD patients, and 4.7 mm in oral steroid-users compared to 2.6 in non-steroid-users (p < 0.05). S-elastin-peptides (SEP) and P-elastase-alpha1-antitrypsin-complexes (PEAC) were negatively correlated to FEV1 in COPD-patients. However, SEP, beta-agonist-treatment, and FEV1 was positively correlated to expansion by multivariate regression analysis, while PEAC and S-alpha1-antitrypsin did not influence expansion, suggesting elastase plays a major role in the pathogenesis of COPD but not in AAA. The high prevalence of AAA among patients with COPD is more likely to be caused by medication and coexisting diseases rather than a common pathway of pathogenesis. Udgivelsesdato: 1999-Aug-16

The incidence of abdominal aortic aneurysms (AAA) and ruptured AAA is increasing. One to three percent of deaths among 65-80 year-old males are caused by AAA. Sixty-six to ninety-five percent of ruptured AAA are lethal, while elective resection has a 3-6% operative mortality. Most AAA's are asymptomatic before rupture. Ultrasonographic scanning of the aorta takes below ten minutes with close to 100% sensitivity and specificity. The County of Viborg has started a randomized screening trial including 13,500 65-73 year-old males. Half of these are invited to the nearest hospital over a period of three years. In 1994-1995 4938 were invited and 3748 were scanned, resulting in an acceptance rate of 76%. The aorta was visible in 99.7%, and the total time consumption was 9.7 minutes per scan. The costs were 83.75 DKK per scan. One hundred and fifty-three (4.1%) had an AAA defined as an aortic diameter above 29 mm. Twenty were above 49 mm and were offered operation, i.e. 5.3 per thousand scans or 13% of the diagnosed AAA.

In spite of increasing number of elective resections of abdominal aortic aneurysms (AAA) the mortality or ruptured AAA is increasing. The advantages of elective operations are obvious; the lethality is 2-6% while the lethality of ruptured AAA is 75-95%. However, AAA seldom causes symptoms before rupture. Ultrasonographic screening for AAA takes 10 minutes per scan, and the sensitivity and specificity are high. Ultrasonographic screening for AAA is a reliable, safe and inexpensive method for screening, and screening for AAA is discussed worldwide. One point four percent of deaths among men from 65 to 80 year of age are caused by ruptured AAA. Screening men over 65 for AAA can theoretically prevent a substantial number of deaths. Our calculations predict one prevented AAA-death per 200-300 scans for a cost of about 4000 DKK per saved year of life. However, cost-benefit analyses are based on uncertain assumptions concerning prevalence, incidence and risk of rupture. Therefore a randomized trial screening of 65-73 year old males is taking place in the County of Viborg in Denmark.

In spite of increasing number of elective resections of abdominal aortic aneurysms (AAA) the mortality or ruptured AAA is increasing. The advantages of elective operations are obvious; the lethality is 2-6% while the lethality of ruptured AAA is 75-95%. However, AAA seldom causes symptoms before rupture. Ultrasonographic screening for AAA takes 10 minutes per scan, and the sensitivity and specificity are high. Ultrasonographic screening for AAA is a reliable, safe and inexpensive method for screening, and screening for AAA is discussed worldwide. One point four percent of deaths among men from 65 to 80 year of age are caused by ruptured AAA. Screening men over 65 for AAA can theoretically prevent a substantial number of deaths. Our calculations predict one prevented AAA-death per 200-300 scans for a cost of about 4000 DKK per saved year of life. However, cost-benefit analyses are based on uncertain assumptions concerning prevalence, incidence and risk of rupture. Therefore a randomized trial screening of 65-73 year old males is taking place in the County of Viborg in Denmark. Udgivelsesdato: 1997-Mar-24

In spite of increasing number of elective resections of abdominal aortic aneurysms (AAA) the mortality or ruptured AAA is increasing. The advantages of elective operations are obvious; the lethality is 2-6% while the lethality of ruptured AAA is 75-95%. However, AAA seldom causes symptoms before rupture. Ultrasonographic screening for AAA takes 10 minutes per scan, and the sensitivity and specificity are high. Ultrasonographic screening for AAA is a reliable, safe and inexpensive method for screening, and screening for AAA is discussed worldwide. One point four percent of deaths among men from 65 to 80 year of age are caused by ruptured AAA. Screening men over 65 for AAA can theoretically prevent a substantial number of deaths. Our calculations predict one prevented AAA-death per 200-300 scans for a cost of about 4000 DKK per saved year of life. However, cost-benefit analyses are based on uncertain assumptions concerning prevalence, incidence and risk of rupture. Therefore a randomized trial screening of 65-73 year old males is taking place in the County of Viborg in Denmark.

The incidence of abdominal aortic aneurysms (AAA) and ruptured AAA is increasing. One to three percent of deaths among 65-80 year-old males are caused by AAA. Sixty-six to ninety-five percent of ruptured AAA are lethal, while elective resection has a 3-6% operative mortality. Most AAA's are asymptomatic before rupture. Ultrasonographic scanning of the aorta takes below ten minutes with close to 100% sensitivity and specificity. The County of Viborg has started a randomized screening trial including 13,500 65-73 year-old males. Half of these are invited to the nearest hospital over a period of three years. In 1994-1995 4938 were invited and 3748 were scanned, resulting in an acceptance rate of 76%. The aorta was visible in 99.7%, and the total time consumption was 9.7 minutes per scan. The costs were 83.75 DKK per scan. One hundred and fifty-three (4.1%) had an AAA defined as an aortic diameter above 29 mm. Twenty were above 49 mm and were offered operation, i.e. 5.3 per thousand scans or 13% of the diagnosed AAA. Udgivelsesdato: 1997-Mar-24

The incidence of abdominal aortic aneurysms (AAA) and ruptured AAA is increasing. One to three percent of deaths among 65-80 year-old males are caused by AAA. Sixty-six to ninety-five percent of ruptured AAA are lethal, while elective resection has a 3-6% operative mortality. Most AAA's are asymptomatic before rupture. Ultrasonographic scanning of the aorta takes below ten minutes with close to 100% sensitivity and specificity. The County of Viborg has started a randomized screening trial including 13,500 65-73 year-old males. Half of these are invited to the nearest hospital over a period of three years. In 1994-1995 4938 were invited and 3748 were scanned, resulting in an acceptance rate of 76%. The aorta was visible in 99.7%, and the total time consumption was 9.7 minutes per scan. The costs were 83.75 DKK per scan. One hundred and fifty-three (4.1%) had an AAA defined as an aortic diameter above 29 mm. Twenty were above 49 mm and were offered operation, i.e. 5.3 per thousand scans or 13% of the diagnosed AAA.

Udgivelsesdato: 1996-null OBJECTIVE - To analyse the benefits of screening older men for abdominal aortic aneurysms. METHODS - A hospital based screening trial concerning 13 500 65-73 year old men using B-mode ultrasonographic scanning. To improve the response rate the invited men could change their appointment, and nonresponders were reinvited. RESULTS - Results from the first year of the trial are presented. Among 4404 invited, 3344 (76%) were scanned. The primary response rate was 64.8%, but a further 11.2% were scanned after revised appointments or reinvitation. The whole infrarenal aorta could be visualised in 97-6%, and the distal part in 99.7% of the scans. The time taken for each scan was 9-7 minutes and the costs per scan were $9.50. One hundred and fifty three subjects (4.6%) had aortic diameters of 25-29 min, and 141 (4.2%) had an abdominal aortic aneurysm, 19 (0.6%) above 49 mm in diameter. CONCLUSION - In Denmark the short term costs and benefits of screening older men for abdominal aortic aneurysms seem realistic. Long term costs and benefits need to be investigated.

In order to analyze the possible benefits on the mortality of abdominal aortic aneurysms (AAA) in Viborg county from the establishment of a specialized vascular unit in the county, the periods just before (1986-1988) and just after (1989-1991) the start of the unit were reviewed. Three times as many operations for AAA (104/mill/yr) were carried out after the unit opened. Acute operations increased sevenfold. In 1986-1988 42 persons experienced rupture of AAA. Twenty-six (63%) died outside hospital. Thirteen (32%) died at primary receiving hospitals. Only three patients (7%) were operated. One survived, making the overall mortality 97.5%. The mortality in this period was 187/million persons over 50 years. In 1989-1991 39 persons experienced rupture. Eleven (28%) died outside hospital. Eight (20.5%) died at primary receiving hospitals. One died preoperatively on the vascular unit. Nineteen (49%) reached operation, 13 survived (33%) and six (15.4%) died postoperatively. The overall mortality was 67%, the mortality of AAA was 127/million persons over 50 years. Comparing the two periods, deaths, mortality and overall mortality due to ruptured AAA decreased by 32% after the introduction of the vascular unit.

Udgivelsesdato: 1995-Nov OBJECTIVES: To analyse the effect on the mortality associated with abdominal aortic aneurysms, due to the establishment of a decentralised vascular surgical unit in the county of Viborg. METHODS: Death after aneurysm repair and from rupture without repair were analysed retrospectively for the 3 year period before (1986-88), and after (1989-91), the unit was established. RESULTS: Between 1986 and 1988, one patient (5%) died after 19 elective and three emergency non-ruptured aneurysm repairs. Only three ruptures were repaired with two deaths. In the country, 41 deaths due to ruptured aneurysm were recorded. Between 1989 and 1991 two patients (4%) died after 26 elective and 27 emergency non-ruptured aneurysm repairs. Nineteen ruptures were repaired with six deaths (32%). In the county, 28 deaths due to rupture were recorded during this period. CONCLUSIONS: The establishment of a decentralised vascular surgical unit has increased the proportion of ruptured aneurysms reaching surgery with a resultant decrease in mortality from this condition.

In order to analyze the possible benefits on the mortality of abdominal aortic aneurysms (AAA) in Viborg county from the establishment of a specialized vascular unit in the county, the periods just before (1986-1988) and just after (1989-1991) the start of the unit were reviewed. Three times as many operations for AAA (104/mill/yr) were carried out after the unit opened. Acute operations increased sevenfold. In 1986-1988 42 persons experienced rupture of AAA. Twenty-six (63%) died outside hospital. Thirteen (32%) died at primary receiving hospitals. Only three patients (7%) were operated. One survived, making the overall mortality 97.5%. The mortality in this period was 187/million persons over 50 years. In 1989-1991 39 persons experienced rupture. Eleven (28%) died outside hospital. Eight (20.5%) died at primary receiving hospitals. One died preoperatively on the vascular unit. Nineteen (49%) reached operation, 13 survived (33%) and six (15.4%) died postoperatively. The overall mortality was 67%, the mortality of AAA was 127/million persons over 50 years. Comparing the two periods, deaths, mortality and overall mortality due to ruptured AAA decreased by 32% after the introduction of the vascular unit. Udgivelsesdato: 1995-Dec-18

Seventy-two operations for abdominal aortic aneurysm (AAA), i.e 104 per mill. per year, were carried out by a vascular surgical unit integrated into a general surgical department. Mortality rate for elective operation was 3.8%, for acute operation without rupture 3.8% and with rupture 31.6%. Fifty percent of patients with rupture reached operation, which gives an overall mortality of about 66% and an incidence of 56 per mill. per year. Twice as many acute operations were carried out in this area compared to the rest of Denmark, and no haemodialysis-demanding complications occurred. These observations suggest that short transfer time is an important prognostic factor when treating ruptured AAA.

In June 1988 a Department of Vascular Surgery was established in the County of Viborg, Denmark. In a retrospective study, 314 patients had 337 major amputations within two time periods: 1986-1987, and 1989-1990. The number of patients seen by a vascular surgeon rose significantly from 19% in the first period to 49% in the last period, and the number of amputations was concurrently significantly reduced by 25%. The largest reduction was observed in 1990, probably due to an increase of vascular reconstructions of 43%. Assuming there is a latency between diagnosing "critical leg ischaemia" and amputation, this will further delay the already convincing results showing that vascular surgery does reduce the frequency of amputations. All patients with suspected critical leg ischaemia or threatened by amputation must be seen, or at least conferred with a vascular surgeon.

In June 1988 a Department of Vascular Surgery was established in the County of Viborg, Denmark. In a retrospective study, 314 patients had 337 major amputations within two time periods: 1986-1987, and 1989-1990. The number of patients seen by a vascular surgeon rose significantly from 19% in the first period to 49% in the last period, and the number of amputations was concurrently significantly reduced by 25%. The largest reduction was observed in 1990, probably due to an increase of vascular reconstructions of 43%. Assuming there is a latency between diagnosing "critical leg ischaemia" and amputation, this will further delay the already convincing results showing that vascular surgery does reduce the frequency of amputations. All patients with suspected critical leg ischaemia or threatened by amputation must be seen, or at least conferred with a vascular surgeon. Udgivelsesdato: 1993-Nov-15