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
thought it appropriate to commemorate the 20th Anni-
versary by performing a series of investigations based
on the Registry, which by November 2007 contained
information on 158.000 open and endovascular proce-
dures. At the tenth Anniversary a series of articles
were published as a supplement to the European Jour-
nal of Surgery.1 This time we decided to publish
independent original articles to benefit from the peer re-
view and to reach a greater readership. We have agreed
to submit the papers to the EJVES, the first paper being
published in this edition reporting on vascular injuries.
All patients at risk being nested prospectively in the
Registry cohort, and the great number of observations,
represent major methodological advantages, when an-
alyzing risk-factors for events in a case-control design.
This enabled us to analyze uncommon procedures
such as operations for acute occlusion of the superior
mesenteric artery2 or popliteal artery aneurysms,3 as
well as uncommon events such as colonic ischaemia
after aortoiliac surgery4 or stroke after carotid TEA.5
Two papers in this series will study less common pro-
cedures such as interventions for upper extremity is-
chaemia and renovascular disease.
A major limitation of registry-data is the validation.
We have invested a large amount of work in validat-
ing the Registry, and we are aware of the problems.
The Swedish system with a unique personal identity
code makes it possible to cross-match data in different
registries on an individual level. It is possible to iden-
tify patients who were operated on and registered in
the In-Patient Registry, but not registered in the Swed-
vasc, and then study their survival by cross-matching
with the Population Registry. We were given permis-
sion by the Health Authorities to perform this valida-
tion regarding mortality after surgery for AAA, and
those data will be published.
The most common open surgical procedures, repre-
senting core surgery, are being registered with great
DOI of original article: 10.1016/j.ejvs.2007.09.010.
*
The authors are members of the Steering Committee of the
Swedvasc.
1078–5884/000129 + 02 $34.00/0 Ó 2007 European Society for Vascular Surgery. Published by Elsevier Ltd. All rights reserved.
validity. This, however, may not be true for endovascu-
lar procedures, due to incomplete registration, with the
exception of EVAR. The original variables established
in 1987 did not reflect the complexity of modern endo-
vascular procedures. In close collaboration with the
Seldinger Society for Vascular and Interventional Radi-
ology a new release of the Registry is launched, where
these problems have been dealt with. Another potential
problem is the fact that the same patient often un-
dergoes several operations, at the same or different an-
atomical locations. The issue of redo-procedures is in
fact quite complex and has created problems.6 In the
new release we have focused our efforts on primary
procedures for aortic aneurysm, carotid artery stenosis
and lower extremity occlusive disease. The less fre-
quent primary and the redo procedures will still be reg-
istered, but in lesser detail. In addition to the basic and
mandatory data, it will be possible to register data on
temporary projects with specific aims.
One of the aims of the Swedvasc was to serve as an
instrument for quality improvement. The hospital-
specific outcomes of twelve quality indicators have
been followed since year 2000. The outcomes of those
indicators are published openly since 2003, which has
facilitated the quality improvement process.
The large database also makes it possible to describe
the development of vascular surgery over time: The in-
troduction of new technology, changes in indications
for surgery, regional differences, the importance of sur-
geon’s and hospital’s volumes for outcome. Outcome
after AAA-repair for the time period 1994e2005 has al-
ready been described7: The introduction of EVAR re-
sulted in an increased incidence of repair of intact but
not of ruptured AAA. In both groups the peri-operative
mortality decreased over time, despite the fact that
older patients were treated. Thought-provoking time-
trends on surgery for carotid artery stenosis, as well
as lower extremity acute and chronic ischaemia, will
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
is of particular interest in a speciality with rapidly
evolving new technology. The annual report of the
130 Editorial
Swedvasc is published already in April, including 30-
day outcome data from last December. The Registry is
updated every week with data from the Population
Registry, so that survival data are at most three weeks
old. Open information on outcomes after surgery is
being requested by both public and decision-makers
ever more often. Rather than becoming the victims,
we believe we can master the situation ourselves. Sur-
geons who don’t count, don’t count.
References
1 BERGQVIST D, TROËNG T, ELFSTRÖM J, HEDBERG B, LJUNGSTRÖM KG,
NORGREN L et al. Auditing Surgical outcome. Ten years with The
Swedish Vascular Registry-Swedvasc. Eur J Surg 1998;164
(Suppl. 581):1e48.
2 BJÖRCK M, ACOSTA S, LINDBERG F, TROËNG T, BERGQVIST D. Revascu-
larisation of the superior mesenteric artery after acute thrombo-
embolic occlusion. Br J Surg 2002;89:923e927.
3 RAVN H, BJÖRCK M. Popliteal artery aneurysm with acute ischemia
in 229 patients. Outcome after thrombolytic and surgical therapy.
Eur J Vasc Endovasc Surg 2007;33:690e695.
Eur J Vasc Endovasc Surg Vol 35, February 2008
4 BJÖRCK M, BERGQVIST D, TROËNG T. Incidence and clinical presenta-
tion of bowel ischaemia after aortoiliac surgery e 2930 operations
from a population-based registry in Sweden. Eur J Vasc Endovasc
Surg 1996;12:139e149.
5 KRAGSTERMAN B, PÄRSSON H, BERGQVIST D, BJÖRCK M. Outcomes of
carotid endarterectomy for asymptomatic stenosis in Sweden
are improvingeresults from a population based registry. J Vasc
Surg 2006;44:79e85.
6 Reoperations, redo surgery and other site interventions constitute
more than one third of vascular surgery. A study from Swedvasc e
the Swedish Vascular Registry. Eur J Vasc Endovasc Surg 1997;14:
244e251.
7 WANHAINEN A, BYLUND N, BJÖRCK M. Abdominal aortic aneurysm
repair in Sweden. Improved outcome over time 1994e2005. Br J
Surg, in Press.
M. Björck*, D. Bergqvist, K. Eliasson
I. Jansson, L. Karlström, B. Kragsterman
A. Lundell, J. Malmstedt, J. Nordanstig
L. Norgren, T. Troëng
The authors are members of
the Steering Committee of the Swedvasc.
Accepted 25 November 2007
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