Læknaneminn - 01.04.2016, Page 32

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trý
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fn
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hjá samsvarandi þýði (e. matched population)
og hefur haldist nokkuð stöðug undanfarna
áratugi þrátt fyrir talsverða framþróun í
aðgerðartækni47,63.
Aðeins 10-18% sjúklinga lifa af rof á ósæð.
Aðrir deyja ýmist samstundis, í flutningi,
fyrir aðgerð, í aðgerð eða innan 30 daga eftir
aðgerð5,7,64,65.
Lokaorð
Ósæðargúll í kviðarholi er lífshættulegur
sjúkdómur og vegur rof þungt sem orsök
dauðsfalla á Vesturlöndum, sér í lagi hjá
eldri karlmönnum. Því er til mikils að vinna
að draga úr breytanlegum áhættuþáttum
ósæðargúla, einkum reykingum sem auka
algengi sjúkdómsins, rofhættu og minnka
lífslíkur í kjölfar aðgerðar. Undanfarna áratugi
hefur verið mikil framþróun í greiningu og
meðferð og hafa rannsóknir stutt ávinning
af skimun áhættuhópa. Auk þess hefur
ósæðarfóðring komið fram á sjónarsviðið sem
góð viðbót við meðferðarúrræði. Mikilvægt
er að læknar og annað heilbrigðisstarfsfólk
muni eftir einkennagefandi ósæðargúlum
sem mismunagreiningu kviðverks enda geta
afleiðingar rofs verið voveiflegar.
Sérstakar þakkir fá Kristbjörn Reynisson og
Áskell Löve röntgenlæknar.
Fengið var upplýst, skriflegt samþykki sjúklings
og birting tilkynnt Persónuvernd.
Heimildaskrá
1. Johnston KW, Rutherford RB, Tilson MD,
Shah DM, Hollier L, Stanley JC. Suggested
standards for reporting on arterial aneurysms.
Subcommittee on Reporting Standards for
Arterial Aneurysms, Ad Hoc Committee on
Reporting Standards, Society for Vascular
Surgery and North American Chapter,
International Society for Cardiovascular
Surgery. J Vasc Surg. 1991;13:452-458.
2. Wassef M, Baxter BT, Chisholm RL,
Dalman RL, Fillinger MF, Heinecke J, et al.
Pathogenesis of abdominal aortic aneurysms:
a multidisciplinary research program
supported by the National Heart, Lung, and
Blood Institute. J Vasc Surg. 2001;34(4):730-
738.
3. Lijnen HR. Metalloproteinases in
development and progression of
vascular disease. Pathophysiol Haemost
Thromb. 2003;33:275-281.
4. Morris DR, Biros E, Cronin O, Kuivaniemi
H, Golledge J. The association of genetic
variants of matrix metalloproteinases
with abdominal aortic aneurysm: a
systematic review and meta-analysis. Heart.
2014;100(4):295-302.
5. Lederle FA, Johnson GR, Wilson SE,
Gordon IL, Chute EP, Littooy FN, et
al. Relationship of age, gender, race, and
body size to infrarenal aortic diameter. The
Aneurysm Detection and Management
(ADAM) Veterans Affairs Cooperative Study
Investigators. J Vasc Surg. 1997;26(4):595-
601.
6. Kuivaniemi H, Ryer EJ, Elmore JR, Tromp G.
Understanding the pathogenesis of abdominal
aortic aneurysms. Expert Rev Cardiovasc
Ther. 2015;13(9):975-987.
7. Chaikof EL, Brewster DC, Dalman RL,
Makaroun MS, Illig KA, Sicard GA, et al.
The care of patients with an abdominal aortic
aneurysm: the Society for Vascular Surgery
practice guidelines. J Vasc Surg. 2009;50(4
Suppl):S2-49.
8. Singh K, Bønaa KH, Jacobsen BK, Bjørk L,
Solberg S. Prevalence of and risk factors for
abdominal aortic aneurysms in a population-
based study: The Tromsø Study. Am J
Epidemiol. 2001;154(3):236-244.
9. Lederle FA, Johnson GR, Wilson SE.
Abdominal aortic aneurysm in women. J Vasc
Surg. 2001;34:122-126.
10. Pleumeekers HJ, Hoes AW, van der DE, van
UH, Hofman A, de Jong PT, et al. Aneurysms
of the abdominal aorta in older adults.
The Rotterdam Study. Am J Epidemiol.
1995;142:1291-1299.
11. Eickhoff JH. Incidence of diagnosis,
operation and death from abdominal aortic
aneurysms in Danish hospitals: results from
a nation-wide survey, 1977-1990. Eur J Surg.
1993;159:619-623. 
12. Drott C, Arfvidsson B, Ortenwall P,
Lundholm K. Age-standardized incidence
of ruptured aortic aneurysm in a defined
Swedish population between 1952 and 1988:
mortality rate and operative results. Br J Surg.
1992;79:175-79. 
13. Svensjö S, Björck M, Gürtelschmid M,
Djavani Gidlund K, Hellberg A, Wanhainen
A. Low prevalence of abdominal aortic
aneurysm among 65-year-old Swedish men
indicates a change in the epidemiology of the
disease. Circulation. 2011;124(10):1118-1123.
14. Anjum A, von Allmen R, Greenhalgh
R, Powell JT. Explaining the decrease in
mortality from abdominal aortic aneurysms
rupture. Br J Surg. 2012;99(5):637-645.
15. Kent KC, Zwolak RM, Egorova NN, Riles
TS, Manganaro A, Moskowitz AJ, et al.
Analysis of risk factors for abdominal aortic
aneurysm in a cohort of more than 3 million
individuals. J Vasc Surg. 2010;52(3):539-548.
16. Vardulaki KA, Walker NM, Day NE, Duffy
SW, Ashton HA, Scott RA. Quantifying the
risks of hypertension, age, sex and smoking in
patients with abdominal aortic aneurysm. Br J
Surg. 2000;87(2):195-200.
17. De Rango P, Farchioni L, Fiorucci B, Lenti
M. Diabetes and abdominal aortic aneurysms.
Eur J Vasc Endovasc Surg. 2014;47(3):243-
261.
18. Larsson E, Granath F, Swedenborg J,
Hultgren R. A population-based case-control
study of the familial risk of abdominal aortic
aneurysm. J Vasc Surg. 2009;49(1):47.
19. Moll FL, Powell JT, Fraedrich G, Verzini F,
Haulon S, Waltham M, et al. Management of
abdominal aortic aneurysms clinical practice
guidelines of the European society for
vascular surgery. Eur J Vasc Endovasc Surg.
2011;41 Suppl 1:S1-S58.
20. Bhak RH, Wininger M, Johnson GR,
Lederle FA, Messina LM, Ballard DJ, et
al. Factors associated with small abdominal
aortic aneurysm expansion rate. JAMA Surg.
2015;150(1):44-50.
21. Lederle FA, Wilson SE, Johnson GR, Reinke
DB, Littooy FN, Acher CW, et al. Immediate
repair compared with surveillance of small
abdominal aortic aneurysms. N Engl J Med.
2002;346(19):1437-1444.
22. Sweeting MJ, Thompson SG, Brown LC,
Powell JT, et al. Meta-analysis of individual
patient data to examine factors affecting
growth and rupture of small abdominal aortic
aneurysms. Br J Surg. 2012;99(5):655-665.
23. The United Kingdom Small Aneurysm
Trial Participants. Long-Term Outcomes
of Immediate Repair Compared with
Surveillance of Small Abdominal Aortic
Aneurysms. N Engl J Med. 2002;346:1445-
1452.
24. Salomaa V, Riley W, Kark JD, Nardo
C, Folsom AR. Non-insulin-dependent
diabetes mellitus and fasting glucose and
insulin concentrations are associated with
arterial stiffness indexes: the ARIC Study.
Circulation. 1995;91(5):1432-1443.
25. Chervu A, Clagett GP, Valentine RJ, Myers
SI, Rossi PJ. Role of physical examination
in detection of abdominal aortic aneurysms.
Surgery. 1995;117(4):454-457.