Decreased mortality of abdominal aortic aneurysms in a peripheral county

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 county, 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

Completeness and positive predictive value of registration of upper limb embolectomy in the Danish National Vascular Registry

Ljubica V Andersen1, Leif S Mortensen2, Jes S Lindholt3, Ole Faergeman4, Eskild W Henneberg3, Lars Frost51Department of Pharmacology, Odense University Hospital, Denmark; 2UNI-C, The Danish IT Centre for Education and Research, Aarhus, Denmark; 3Vascular Research Unit, Department of Vascular Surgery, Viborg Hospital, Denmark; 4Department of Cardiology and Internal Medicine, Aarhus University Hospital, Denmark; 5Department of Medicine, Silkeborg Hospital, DenmarkObjective: To evaluate completeness and positive predictive value of the Danish National Vascular Registry regarding registration of the surgical procedures: embolectomy of brachial, ulnar, or radial artery. Study design and settings: The study was based on first-time embolectomies in the brachial, ulnar, or radial artery performed in Denmark from January 1, 1990 to December 31, 2002. The data were primarily retrieved from the Danish National Vascular Registry and secondarily from the Danish National Registry of Patients. Medical records were retrieved using a standardized form.Results: In total, 1433 incident cases of first-time embolectomy were found in both registries. The positive predictive value of the registration was 97.5% (95% confidence interval [CI]; 96.4–98.4). The degree of completeness was 86.5% (95% CI; 84.3–88.5). For the registration period from 1990 till 1996 the degree of completeness was 78.2% (95% CI; 74.4–81.7), and from 1997 till 2002 it was 93.8% (95% CI; 91.6–95.7). Conclusion: The completeness and positive predictive value of registration of embolectomy in the upper limb in the Danish National Vascular Registry was 86.5% and 97.5%, respectively. This registry can be a valuable tool for epidemiological research and quality-monitoring. Keywords: positive predictive value, completeness, capture-recapture method, validity, embolectomy, registration

The Viborg vascular (VIVA) screening trial of 65-74 year old men in the central region of Denmark: study protocol

<p>Abstract</p> <p>Background</p> <p>Screening for abdominal aortic aneurysm (AAA) of men aged 65-74 years reduces the AAA-related mortality and is generally considered cost effective. Despite of this only a few national health care services have implemented permanent programs.</p> <p>Around 10% of men in this group have peripheral arterial disease (PAD) defined by an ankle brachial systolic blood pressure index (ABI) below 0.9 resulting in an increased mortality-rate of 25-30%. In addition well-documented health benefits may be achieved through primary prophylaxis by initiating systematic cholesterol-lowering, smoking cessation, low-dose acetylsalicylic acid (aspirins), exercise, a healthy diet and blood-pressure control altogether reducing the increased risks for cardiovascular disease by at least 20-25%.</p> <p>The benefits of combining screening for AAA and PAD seem evident; yet they remain to be established. The objective of this study is to assess the efficacy and the cost-effectiveness of a combined screening program for AAA, PAD and hypertension.</p> <p>Methods</p> <p>The Viborg Vascular (VIVA) screening trial is a randomized, clinically controlled study designed to evaluate the benefits of vascular screening and modern vascular prophylaxis in a population of 50,000 men aged 65-74 years. Enrolment started October 2008 and is expected to stop in October 2010. The primary outcome is all-cause mortality. The secondary outcomes are cardiovascular mortality, AAA-related mortality, hospital services related to cardiovascular conditions, prevalence of AAA, PAD and potentially undiagnosed hypertension, health-related quality of life and cost effectiveness. Data analysis by intention to treat.</p> <p>Results</p> <p>Major follow-up will be performed at 3, 5 and 10 years and final study result after 15 years.</p> <p>Trial registration</p> <p>ClinicalTrials.gov NCT00662480</p