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About me

I am a vascular surgeon and have worked in Stockholm since 10 years. My PhD thesis, titled "Diabetes and Peripheral Arterial Disease" was presented in 2012 at the Department of Molecular Medicine and Surgery at Karolinska Institute. Since March 2014 I have a 50% post-doc scholarship in combination with clinical work at the Vascular section, the  Department of Surgery, Södersjukhuset. I am a member if the SOSVASC research group at the Department of Clinical Science and Education, Södersjukhuset.

My clinical interest for diabetes and peripheral arterial disease coincides with my main line of research. My aim is to work translational based on the clinical problems associated with peripheral arterial disease (PAD) and diabetes.

Education

Medical doctor 1995, University of Linköping

Specialist in General Surgery 2003

Specialist in Vascular Surgery 2005

PhD 2012, Karolinska Institute.

Research description

Projects

  • What is the cause of the rapid progression of arteriosclerosis and intimal hyperplasia in diabetic patients?

In patients with diabetes advanced glycation end products (AGE) are produced. These compounds have several effects on the wall structure as well as the fuction of the arterial vessels. In animal studies it has been well described how the AGE products induces arteriosclerosis and stimulates intimal hyperplasia thru specific receptors in the vessel wall. Intimal hyperplasia is an exaggerated healing process in the arterial wall that incuses stenoses and occlusions after vascular procedures such as by-pass and angioplasty.

We are trying to describe if the mechanisms shown in the animal models also are present in humans. We have described the presence of AGE and RAGE in the veins used in by-pass surgery of the lower extremities.

  • Why is the neo-formation of muscle vessels impaired in diabetic patients?

In this project we study the factors that inhibit neo-formation of vessels (angiostatic factors) in muscle. In diabetic patients the compensatory mechanisms for impaired circulation (in PAD) is reduced and neo-formation process is defected. The mechanism behind this is not fully understood. We will compare muscle samples from patients with, and without diabetes (and with, and without PAD ) at a molecular biologic level. The project is a collaboration with Ass prof Thomas Gustafsson at the Research group of Integrative Clinical Physiology and Ass Prof Tara Haas at the York University in Canada.

Other ongoing projects

The role of the intimal wall of the artery in bloodclot formation

  • Treatment results of PAD in a 20-year perspective
  • Does better perioperative glucose control reduce complications?
  • Post traumatic care in blast and gunshot extremity wounds. PhD project for Andres Älgå (I am co-supervisor in this thesis projekt). We have randomized 70 patientes comparing vacuum assisted clusure with conventional wound treatment. Additionally we have shown an association between infection after traumatic injuries to the lower extremities och risk for amputation and death independent of age, gender and traumascore. Aside from our data - collecten on site - we collect data from the Red Cross registry in Pakistan. 
  •  Trombocyte inhibition in PAD. PhD project for Ove Thott (I am co-supervisor)
  • Cellular mechaniwsm in intimal hyperplasia and diabetes. PhD project for Robert Saxelin (I am co-supervisor)
  • We plan to investigate diagnoses in vascular surgery in patients subjected to pelvic radiotherapy. The project is a collaboration with Åsa Hallqvist Everhov, Peter Gillgren and Karin Ekström Smedby.
  • I am co-supervisor to Eva Torbjörnsson in her PhD project. Eva studies the risk of amputation and quality of life in patients who have undergone amputation. The studies are populationbased cohorts from Stockholm, Sweden.
  • I am principle investigator for the Basil-2 trial. A randomized multi-centre trial from University of Birmingham. The objective is to find out if a "vein by-pass first" or a "best endovascular first" revascularisation strategy is best, in terms of either clinical or cost-effectiviness, for severe limb ischemia due to infra-popliteal disease.
  • We study the results after treatment for primary trmbosis of the subclavian vein. This is a project in collaboration with Carl-Magnus Wahlgren and Peter Gillgren along with a medical student (Sara Lindblom)
  • Natural History of Peripheral Arterial Disease

    Fredrik Sartipy M.D., has a PhD project. In collaboration with Dr Birgitta Sigvant, Karlstad's Central Hospital, and Professor Eric Wahlberg at Linköping University. I am co-supervisor. Sartipy will study quality of life, disease panorama and death in patients with PAD. Sigvant holds a PhD in the subject and a large cohort of patients is in our database already

SEVEN SELECTED PUBLICATIONS

Long-Term Outcome After Carotid Artery Stenting: A Population-Based Matched Cohort Study.
Jonsson M, Lindström D, Gillgren P, Wanhainen A, Malmstedt J
Stroke 2016 Aug;47(8):2083-9

Influence of perioperative blood glucose levels on outcome after infrainguinal bypass surgery in patients with diabetes.
Malmstedt J, Wahlberg E, Jörneskog G, Swedenborg J
Br J Surg 2006 Nov;93(11):1360-7

Outcome after leg bypass surgery for critical limb ischemia is poor in patients with diabetes: a population-based cohort study.
Malmstedt J, Leander K, Wahlberg E, Karlström L, Alfredsson L, Swedenborg J
Diabetes Care 2008 May;31(5):887-92

Outcomes of endovascular abdominal aortic aneurysm repair compared with open surgical repair in high-risk patients: results from the Swedish Vascular Registry.
Wahlgren C, Malmstedt J,
J. Vasc. Surg. 2008 Dec;48(6):1382-8; discussion 1388-9

External validation of the Swedvasc registry: a first-time individual cross-matching with the unique personal identity number.
Troëng T, Malmstedt J, Björck M
Eur J Vasc Endovasc Surg 2008 Dec;36(6):705-12

A randomized prospective study of valvulotome efficacy in in situ reconstructions.
Malmstedt J, Takolander R, Wahlberg E
Eur J Vasc Endovasc Surg 2005 Jul;30(1):52-6

Analyte flux at a biomaterial-tissue interface over time: implications for sensors for type 1 and 2 diabetes mellitus.
Ekberg N, Brismar K, Malmstedt J, Hedblad M, Adamson U, Ungerstedt U, et al
J Diabetes Sci Technol 2010 Sep;4(5):1063-72

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