Maarit Venermo

Background: Women have been underrepresented in peripheral artery disease revascularization trials. We aimed to analyze sex‐specific outcomes after endovascular therapy (EVT) with stent implantation versus bypass surgery (BSx) in patients with symptomatic femoropopliteal peripheral artery disease, leveraging data from the REVIVE (Revascularization Strategies in Patients With Peripheral Arterial Disease Involving the Femoropopliteal Arteries) study. Methods: The REVIVE study pooled individual patient data from 5 randomized controlled trials comparing EVT with stent implantation versus BSx. The primary end point was major adverse limb events, a composite of all‐cause death, major amputation, or reintervention. Secondary end points included amputation‐free survival, the individual components of major adverse limb events, and primary patency at 2 years. Early complications were defined as a composite of any bleeding, infection, or all‐cause death within 30 days. Results: Of 639 patients, 185 (29.0%) were women. At 2 years, there were no significant differences in major adverse limb events between EVT and BSx in women (40.6% versus 42.1%; adjusted hazard ratio [aHR], 0.93 [95% CI, 0.57–1.52]) and men (39.7% versus 34.4%; aHR, 0.98 [95% CI, 0.69–1.39]; P ‐interaction=0.963). Similarly, there were no differences in secondary end points between EVT and BSx, regardless of sex. EVT, compared with BSx, was associated with lower rates of early complications (8.7% versus 25.9%, P =0.002 in women and 5.9% versus 21.5%, P P ‐interaction =0.77) and shorter hospital stay (3.7±5.7 versus 7.2±4.3 days, P P <0.001 in men). Conclusions: Our analysis supports the efficacy and safety of EVT with stent implantation as an alternative to BSx in patients with symptomatic peripheral artery disease involving the femoropopliteal segment, regardless of sex.

Background and aims: Over recent decades, the management of abdominal aortic aneurysms (AAAs) has undergone substantial transformation, influenced by the introduction of minimally invasive endovascular aneurysm repair (EVAR), advances in early detection, a reduction in disease prevalence, and aging. This study investigated long-term trends in AAA repair incidence, treatment modality, and mortality outcomes across Denmark, Finland, Norway, and Sweden—four neighboring countries with comparable healthcare systems and registry infrastructures. Methods: National registry data were used to identify intact (iAAA) and ruptured abdominal aortic aneurysm (rAAA) repairs from 1998 to 2017 (2008–2017 for Norway). Repair incidence, treatment modality (EVAR vs open repair (OAR)), and mortality (30-day and 1-year) were calculated and compared by country, age group, sex, and time period. Life-table analyses assessed long-term survival. Results: We identified 39,683 iAAA and 15,086 rAAA repairs. During the study, iAAA repair incidence rose markedly among octogenarians, while rAAA repair incidence declined across all countries. EVAR usage increased over time for both iAAA (11.0%–54.1%) and rAAA (2.5%–24.3%). Perioperative mortality declined throughout the study, with 30-day mortality after iAAA repair falling to 1.9% and after rAAA repair to 27.3%. One‑year mortality similarly improved: for iAAA, it reached 5.9%, and for rAAA, it reached 35.8%. Women had consistently higher 30-day and 1-year mortality than men across all procedure types. Outcomes and survival trends were largely similar between the four countries. Conclusion: In the Nordic countries, rAAA repair incidence decreased substantially between 1998 and 2017. EVAR adoption increased and was associated with a rising incidence of iAAA repair in octogenarians. Mortality rates were comparable across the four countries and declined over time for both iAAA and rAAA repair. However, females had consistently poorer perioperative survival than males.

The impact of diagnostic delays on wound healing has not been investigated in the primary care setting. The aim of this cohort study was to examine how diagnostic delays influence the healing of a chronic wound. This is a retrospective study on patients who were assessed by a specialized wound care team of a primary health care unit, aiming to reduce diagnostic and treatment delays among patients with chronic wounds. The data consist of 197 consecutive patients who had their first appointment with the wound care team in 2016. Patients whose wounds had appeared less than one year prior to the diagnosis (n = 182) were included in the analyses. Primary and secondary outcome measures: The primary outcome measure was wound healing and its association with a diagnostic delay. Delays were categorized into three groups by the date of the diagnosis: (1) less than 4 weeks (n = 33), (2) 4–12 weeks (n = 94) and (3) over 12 weeks (n = 55) after the appearance of the wound. A diagnostic delay had a significant effect on the wound healing time. Wounds had a shorter healing time if they were diagnosed early. The cumulative healing rate at 12 weeks was 54.5% in Group 1, 17.0% in Group 2 and 0% in Group 3. And 62.5% of the arterial ulcers and 47.8% of the diabetic ulcers were diagnosed within 4–12 weeks. Most of the venous leg ulcers were diagnosed within 4–12 weeks (54.2%). Our data clearly show that the earlier the diagnosis, the shorter the healing time in a primary care setting. The wounds that were diagnosed the earliest were mainly post‐traumatic and venous leg ulcers. On the other hand, wounds requiring prompt diagnosis, such as diabetic foot ulcers and arterial ulcers, were not included in the group of early diagnosis. We conclude that a speedy diagnosis and aetiology‐driven treatment of a wound has a direct impact on the wound healing time. Therefore, it is essential to improve the diagnostic pathways from the onset of the wound, starting from the primary care setting.