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Eur J Vasc Endovasc Surg 35, 129e130 (2008)

doi:10.1016/j.ejvs.2007.11.007, available online at http://www.sciencedirect.com on

EDITORIAL

Twenty Years with the Swedvasc Registry*

The Swedvasc Registry started in January 1987. We validity. This, however, may not be true for endovascu-
thought it appropriate to commemorate the 20th Anni- lar procedures, due to incomplete registration, with the
versary by performing a series of investigations based exception of EVAR. The original variables established
on the Registry, which by November 2007 contained in 1987 did not reflect the complexity of modern endo-
information on 158.000 open and endovascular proce- vascular procedures. In close collaboration with the
dures. At the tenth Anniversary a series of articles Seldinger Society for Vascular and Interventional Radi-
were published as a supplement to the European Jour- ology a new release of the Registry is launched, where
nal of Surgery.1 This time we decided to publish these problems have been dealt with. Another potential
independent original articles to benefit from the peer re- problem is the fact that the same patient often un-
view and to reach a greater readership. We have agreed dergoes several operations, at the same or different an-
to submit the papers to the EJVES, the first paper being atomical locations. The issue of redo-procedures is in
published in this edition reporting on vascular injuries. fact quite complex and has created problems.6 In the
All patients at risk being nested prospectively in the new release we have focused our efforts on primary
Registry cohort, and the great number of observations, procedures for aortic aneurysm, carotid artery stenosis
represent major methodological advantages, when an- and lower extremity occlusive disease. The less fre-
alyzing risk-factors for events in a case-control design. quent primary and the redo procedures will still be reg-
This enabled us to analyze uncommon procedures istered, but in lesser detail. In addition to the basic and
such as operations for acute occlusion of the superior mandatory data, it will be possible to register data on
mesenteric artery2 or popliteal artery aneurysms,3 as temporary projects with specific aims.
well as uncommon events such as colonic ischaemia One of the aims of the Swedvasc was to serve as an
after aortoiliac surgery4 or stroke after carotid TEA.5 instrument for quality improvement. The hospital-
Two papers in this series will study less common pro- specific outcomes of twelve quality indicators have
cedures such as interventions for upper extremity is- been followed since year 2000. The outcomes of those
chaemia and renovascular disease. indicators are published openly since 2003, which has
A major limitation of registry-data is the validation. facilitated the quality improvement process.
We have invested a large amount of work in validat- The large database also makes it possible to describe
ing the Registry, and we are aware of the problems. the development of vascular surgery over time: The in-
The Swedish system with a unique personal identity troduction of new technology, changes in indications
code makes it possible to cross-match data in different for surgery, regional differences, the importance of sur-
registries on an individual level. It is possible to iden- geon’s and hospital’s volumes for outcome. Outcome
tify patients who were operated on and registered in after AAA-repair for the time period 1994e2005 has al-
the In-Patient Registry, but not registered in the Swed- ready been described7: The introduction of EVAR re-
vasc, and then study their survival by cross-matching sulted in an increased incidence of repair of intact but
with the Population Registry. We were given permis- not of ruptured AAA. In both groups the peri-operative
sion by the Health Authorities to perform this valida- mortality decreased over time, despite the fact that
tion regarding mortality after surgery for AAA, and older patients were treated. Thought-provoking time-
those data will be published. trends on surgery for carotid artery stenosis, as well
The most common open surgical procedures, repre- as lower extremity acute and chronic ischaemia, will
senting core surgery, are being registered with great be presented in articles to be submitted to this Journal.
One of the great advantages of registry data in the
age of the Internet is the rapid feed-back of data. This
DOI of original article: 10.1016/j.ejvs.2007.09.010.
*
The authors are members of the Steering Committee of the is of particular interest in a speciality with rapidly
Swedvasc. evolving new technology. The annual report of the

1078–5884/000129 + 02 $34.00/0 Ó 2007 European Society for Vascular Surgery. Published by Elsevier Ltd. All rights reserved.
130 Editorial

Swedvasc is published already in April, including 30- 4 BJÖRCK M, BERGQVIST D, TROËNG T. Incidence and clinical presenta-
tion of bowel ischaemia after aortoiliac surgery e 2930 operations
day outcome data from last December. The Registry is from a population-based registry in Sweden. Eur J Vasc Endovasc
updated every week with data from the Population Surg 1996;12:139e149.
Registry, so that survival data are at most three weeks 5 KRAGSTERMAN B, PÄRSSON H, BERGQVIST D, BJÖRCK M. Outcomes of
carotid endarterectomy for asymptomatic stenosis in Sweden
old. Open information on outcomes after surgery is are improvingeresults from a population based registry. J Vasc
being requested by both public and decision-makers Surg 2006;44:79e85.
ever more often. Rather than becoming the victims, 6 Reoperations, redo surgery and other site interventions constitute
more than one third of vascular surgery. A study from Swedvasc e
we believe we can master the situation ourselves. Sur- the Swedish Vascular Registry. Eur J Vasc Endovasc Surg 1997;14:
geons who don’t count, don’t count. 244e251.
7 WANHAINEN A, BYLUND N, BJÖRCK M. Abdominal aortic aneurysm
repair in Sweden. Improved outcome over time 1994e2005. Br J
Surg, in Press.
References
M. Björck*, D. Bergqvist, K. Eliasson
1 BERGQVIST D, TROËNG T, ELFSTRÖM J, HEDBERG B, LJUNGSTRÖM KG, I. Jansson, L. Karlström, B. Kragsterman
NORGREN L et al. Auditing Surgical outcome. Ten years with The
Swedish Vascular Registry-Swedvasc. Eur J Surg 1998;164
A. Lundell, J. Malmstedt, J. Nordanstig
(Suppl. 581):1e48. L. Norgren, T. Troëng
2 BJÖRCK M, ACOSTA S, LINDBERG F, TROËNG T, BERGQVIST D. Revascu- The authors are members of
larisation of the superior mesenteric artery after acute thrombo-
embolic occlusion. Br J Surg 2002;89:923e927.
the Steering Committee of the Swedvasc.
3 RAVN H, BJÖRCK M. Popliteal artery aneurysm with acute ischemia
in 229 patients. Outcome after thrombolytic and surgical therapy. Accepted 25 November 2007
Eur J Vasc Endovasc Surg 2007;33:690e695. Available online 26 December 2007

*Corresponding author. M. Björck, Associate professor Institution of


Surgical Sciences, Department of Vascular Surgery, Uppsala Univer-
sity Hospital, SE 751 85 Uppsala, Sweden.
E-mail address: martin@bjorck.pp.se

Eur J Vasc Endovasc Surg Vol 35, February 2008