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Abstract
We performed a systematic literature search and a meta-analysis to assess the association between diabetes mellitus (DM) and abdominal aortic aneurysm (AAA) growth. Databases including MEDLINE and EMBASE were searched through June 2015 using PubMed and OVID. For each study, data regarding AAA growth rates in both the DM and the non-DM groups were used to generate standardized mean differences (SMDs) and 95% confidence intervals (CIs). Our search identified 19 relevant studies including data on 9777 patients with AAA. Pooled analyses demonstrated a statistically significant slower growth rates in DM patients than in non-DM patients (unadjusted SMD, −0.32; 95% CI, −0.40 to −0.24; P < .00001; adjusted SMD, −0.29; 95% CI, −0.417 to −0.18; P < .00001). Despite possible publication bias in favor of DM based on funnel plot asymmetry, even adjustment of the asymmetry did not alter the beneficial effect of DM. In conclusion, on the basis of a meta-analysis of data on a total of 9777 patients (19 studies) identified through a systematic literature search, we confirmed the association of DM with slower growth rates of AAA.
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Affiliation(s)
- Hisato Takagi
- Department of Cardiovascular Surgery, Shizuoka Medical Center, Shimizu, Japan
| | - Takuya Umemoto
- Department of Cardiovascular Surgery, Shizuoka Medical Center, Shimizu, Japan
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52
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Gharahi H, Zambrano BA, Lim C, Choi J, Lee W, Baek S. On growth measurements of abdominal aortic aneurysms using maximally inscribed spheres. Med Eng Phys 2015; 37:683-91. [PMID: 26004506 DOI: 10.1016/j.medengphy.2015.04.011] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2014] [Revised: 12/26/2014] [Accepted: 04/25/2015] [Indexed: 11/25/2022]
Abstract
The maximum diameter, total volume of the abdominal aorta, and its growth rate are usually regarded as key factors for making a decision on the therapeutic operation time for an abdominal aortic aneurysm (AAA) patient. There is, however, a debate on what is the best standard method to measure the diameter. Currently, two dominant methods for measuring the maximum diameter are used. One is measured on the planes perpendicular to the aneurism's central line (orthogonal diameter) and the other one is measured on the axial planes (axial diameter). In this paper, another method called 'inscribed-spherical diameter' is proposed to measure the diameter. The main idea is to find the diameter of the largest sphere that fits within the aorta. An algorithm is employed to establish a centerline for the AAA geometries obtained from a set of longitudinal scans obtained from South Korea. This centerline, besides being the base of the inscribed spherical method, is used for the determination of orthogonal and axial diameter. The growth rate parameters are calculated in different diameters and the total volume and the correlations between them are studied. Furthermore, an exponential growth pattern is sought for the maximum diameters over time to examine a nonlinear growth pattern of AAA expansion both globally and locally. The results present the similarities and discrepancies of these three methods. We report the shortcomings and the advantages of each method and its performance in the quantification of expansion rates. While the orthogonal diameter measurement has an ability of capturing a realistic diameter, it fluctuated. On the other hand, the inscribed sphere diameter method tends to underestimate the diameter measurement but the growth rate can be bounded in a narrow region for aiding prediction capability. Moreover, expansion rate parameters derived from this measurement exhibit good correlation with each other and with growth rate of volume. In conclusion, although the orthogonal method remains the main method of measuring the diameter of an abdominal aorta, employing the idea of maximally inscribed spheres provides both a tool for generation of the centerline, and an additional parameter for quantification of aneurysmal growth rates.
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Affiliation(s)
- H Gharahi
- Department of Mechanical Engineering, Michigan State University, 2457 Engineering Building, East Lansing, MI 48824, USA
| | - B A Zambrano
- Department of Mechanical Engineering, Michigan State University, 2457 Engineering Building, East Lansing, MI 48824, USA
| | - C Lim
- Department of Statistics and Probability, Michigan State University, East Lansing, MI 48824, USA
| | - J Choi
- Department of Mechanical Engineering, Michigan State University, 2457 Engineering Building, East Lansing, MI 48824, USA; Department of Electrical and Computer Engineering, Michigan State University, East Lansing, MI 48824, USA
| | - W Lee
- Department of Radiology, Seoul National University Hospital, 101 Daehangno, Jongno-gu, Seoul, Republic of Korea
| | - S Baek
- Department of Mechanical Engineering, Michigan State University, 2457 Engineering Building, East Lansing, MI 48824, USA.
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53
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Brunner-Ziegler S, Hammer A, Seidinger D, Willfort-Ehringer A, Koppensteiner R, Steiner S. The role of intraluminal thrombus formation for expansion of abdominal aortic aneurysms. Wien Klin Wochenschr 2015; 127:549-54. [DOI: 10.1007/s00508-015-0798-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2014] [Accepted: 04/21/2015] [Indexed: 11/25/2022]
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54
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Bath MF, Gokani VJ, Sidloff DA, Jones LR, Choke E, Sayers RD, Bown MJ. Systematic review of cardiovascular disease and cardiovascular death in patients with a small abdominal aortic aneurysm. Br J Surg 2015; 102:866-72. [DOI: 10.1002/bjs.9837] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2014] [Revised: 01/05/2015] [Accepted: 03/26/2015] [Indexed: 11/09/2022]
Abstract
Abstract
Background
Screening for abdominal aortic aneurysm (AAA) has reduced the rate of AAA rupture. However, cardiovascular disease is still a major cause of death in men with an AAA. The aim of this study was to assess cardiovascular risk in patients with a small AAA.
Methods
Standard PRISMA guidelines were followed. Analysis was performed of studies reporting cardiovascular outcomes in patients with a small AAA (30–54 mm). Weighted metaregression was performed for cardiovascular death in patients with a small AAA, and the prevalence of cardiovascular disease was reviewed.
Results
Twenty-one articles were identified describing patients with an AAA, and the prevalence of, and death from, cardiovascular disease. Ten of these reported cardiovascular death rates in patients with a small AAA. Some 2323 patients with a small AAA were identified; 335 cardiovascular deaths occurred, of which 37 were due to AAA rupture. Metaregression demonstrated that the risk of cardiovascular death was 3·0 (95 per cent c.i. 1·7 to 4·3) per cent per year in patients with a small AAA (R2 = 0·902, P < 0·001). The prevalence of ischaemic heart disease (44·9 per cent), myocardial infarction (26·8 per cent), heart failure (4·4 per cent) and stroke (14·0 per cent) was also high in these patients.
Conclusion
The risk of cardiovascular death in patients with a small AAA is high and increases by approximately 3 per cent each year after diagnosis. Patients with a small AAA have a high prevalence of cardiovascular disease. Patients a small AAA should be considered for lifestyle modifications and secondary cardiovascular protection.
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Affiliation(s)
- M F Bath
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
| | - V J Gokani
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
| | - D A Sidloff
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
| | - L R Jones
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
| | - E Choke
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
| | - R D Sayers
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
| | - M J Bown
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
- National Institute for Health Research Leicester Cardiovascular Biomedical Research Unit, University of Leicester, Leicester, UK
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55
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Dyer LA. Hypercysteinemia hypes up the inflammasome. J Mol Cell Cardiol 2015; 82:33-5. [PMID: 25758430 DOI: 10.1016/j.yjmcc.2015.02.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2015] [Revised: 02/26/2015] [Accepted: 02/27/2015] [Indexed: 10/23/2022]
Affiliation(s)
- Laura A Dyer
- Department of Natural Sciences, Middle Georgia State College, Macon, GA 31206, USA.
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Smelser DT, Tromp G, Elmore JR, Kuivaniemi H, Franklin DP, Kirchner HL, Carey DJ. Population risk factor estimates for abdominal aortic aneurysm from electronic medical records: a case control study. BMC Cardiovasc Disord 2014; 14:174. [PMID: 25475588 PMCID: PMC4269847 DOI: 10.1186/1471-2261-14-174] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2013] [Accepted: 11/18/2014] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Using abdominal aortic aneurysm (AAA) as a model, this case-control study used electronic medical record (EMR) data to assess known risk factors and identify new associations. METHODS The study population consisted of cases with AAA (n =888) and controls (n =10,523) from the Geisinger Health System EMR in Central and Northeastern Pennsylvania. We extracted all clinical and diagnostic data for these patients from January 2004 to December 2009 from the EMR. From this sample set, bootstrap replication procedures were used to randomly generate 2,500 iterations of data sets, each with 500 cases and 2000 controls. Estimates of risk factor effect sizes were obtained by stepwise logistic regression followed by bootstrap aggregation. Variables were ranked using the number of inclusions in iterations and P values. RESULTS The benign neoplasm diagnosis was negatively associated with AAA, a novel finding. Similarly, type 2 diabetes, diastolic blood pressure, weight and myelogenous neoplasms were negatively associated with AAA. Peripheral artery disease, smoking, age, coronary stenosis, systolic blood pressure, age, height, male sex, pulmonary disease and hypertension were associated with an increased risk for AAA. CONCLUSIONS This study utilized EMR data, retrospectively, for risk factor assessment of a complex disease. Known risk factors for AAA were replicated in magnitude and direction. A novel negative association of benign neoplasms was identified. EMRs allow researchers to rapidly and inexpensively use clinical data to expand cohort size and derive better risk estimates for AAA as well as other complex diseases.
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Affiliation(s)
- Diane T Smelser
- Sigfried and Janet Weis Center for Research, Geisinger Health System, Danville, PA, USA.
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57
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Nguyen V, Leiner T, Hellenthal F, Backes W, Wishaupt M, van der Geest R, Heeneman S, Kooi M, Schurink G. Abdominal Aortic Aneurysms with High Thrombus Signal Intensity on Magnetic Resonance Imaging are Associated with High Growth Rate. Eur J Vasc Endovasc Surg 2014; 48:676-84. [DOI: 10.1016/j.ejvs.2014.04.025] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2013] [Accepted: 04/16/2014] [Indexed: 10/25/2022]
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58
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Assessment of Biomarkers and Predictive Model for Short-term Prospective Abdominal Aortic Aneurysm Growth—A Pilot Study. Ann Vasc Surg 2014; 28:1642-8. [DOI: 10.1016/j.avsg.2014.02.025] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2013] [Revised: 01/25/2014] [Accepted: 02/28/2014] [Indexed: 12/16/2022]
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59
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Growth rates of small abdominal aortic aneurysms assessed by computerised tomography – A systematic literature review. Atherosclerosis 2014; 235:182-8. [DOI: 10.1016/j.atherosclerosis.2014.04.021] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2013] [Revised: 04/11/2014] [Accepted: 04/13/2014] [Indexed: 11/18/2022]
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60
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Diabetes and abdominal aortic aneurysms. Eur J Vasc Endovasc Surg 2014; 47:243-61. [PMID: 24447529 DOI: 10.1016/j.ejvs.2013.12.007] [Citation(s) in RCA: 158] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2013] [Accepted: 12/01/2013] [Indexed: 11/24/2022]
Abstract
Epidemiologic evidence suggests that patients with diabetes may have a lower incidence of abdominal aortic aneurysm (AAA); however, the link between diabetes and AAA development and expansion is unclear. The aim of this review is to analyze updated evidence to better understand the impact of diabetes on prevalence, incidence, clinical outcome, and expansion rate of AAA. A systematic review of literature published in the last 20 years using the PubMed and Cochrane databases was undertaken. Studies reporting appropriate data were identified and a meta-analysis performed using the generic inverse variance method. Sixty-four studies were identified. Methodological quality was "fair" in 16 and "good" in 44 studies according to a formal assessment checklist (Newcastle-Ottawa). In 17 large population prevalence studies there was a significant inverse association between diabetes and AAA: pooled odds ratio (OR) 0.80; 95% confidence intervals (CI) 0.70-0.90 (p = .0009). An inverse association was also confirmed by pooled analysis of data from smaller prevalence studies on selected populations (OR 0.59; 95% CI 0.35-0.99; p = .05), while no significant results were provided by case-control studies. A significant lower pooled incidence of new AAA in diabetics was found over six prospective studies: OR 0.54; 95% CI 0.31-0.91; p = .03. Diabetic patients showed increased operative (30-day/in-hospital) mortality after AAA repair: pooled OR 1.26; 95% CI 1.10-1.44; p = .0008. The increased operative risk was more evident in studies with 30-day assessment. In the long-term, diabetics showed lower survival rates at 2-5 years, while there was general evidence of lower growth rates of small AAA in patients with diabetes compared to non-diabetics. There is currently evidence to support an inverse relationship between diabetes and AAA development and enlargement, even though fair methodological quality or unclear risk of bias in many available studies decreases the strength of the finding. At the same time, operative and long-term survival is lower in diabetic patients, suggesting increased cardiovascular burden. The higher mortality in diabetics raises the question as to whether AAA repair should be individualized in selected diabetic populations at higher AAA rupture risk.
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61
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Theivacumar NS, Stephenson MA, Mistry H, Valenti D. Diabetes mellitus and aortic aneurysm rupture: a favorable association? Vasc Endovascular Surg 2013; 48:45-50. [PMID: 24065625 DOI: 10.1177/1538574413505921] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Recent reports suggest that diabetic patients are relatively unlikely to have abdominal aortic aneurysms (AAAs). This retrospective study assesses the relationship between diabetes mellitus (DM) and aortic aneurysm rupture. METHODS Patients with a diagnosis of any aortic aneurysm during a 10-year period were identified from our records. Patients with diagnoses of aortic aneurysm (thoracic, thoracoabdominal, and abdominal, treated and untreated) were included. Patients with nonatheromatous aneurysms (transection, dissection, mycotic, or isolated iliac) were excluded. RESULTS In all, 1830 patients with nonruptured aneurysms and 232 ruptured aneurysms were included giving a total of 2062 patients with aortic aneurysms (abdominal, thoracic, and thoracoabdominal). Of these 1830, 225 (12.3%) patients with nonruptured aneurysm were diabetic; however, only 13 (5.6%) of the 232 patients with ruptured aortic aneurysm were diabetic (odds ratio [OR] = 0.42; confidence interval [CI]: 0.23-0.75, P = .004). Considering only those with AAAs, 184 (12.4%) of the 1482 nonruptured AAA were diabetic; however, only 12 (6.4%) of the 188 patients with ruptured AAA were diabetic (OR = 0.48 [CI: 0.26-0.88], P = .02). In this study group, the odds of dying due to aneurysm rupture in the diabetic group are significantly lower compared to the nondiabetic groups (OR = 0.31 [CI: 0.13-0.69], P = .004), despite the finding that diabetic patients had almost the same life expectancy as nondiabetic patients (DM, 73 years [67-80] vs non-DM, 75 years [68-82] P = .23). CONCLUSIONS Diabetic patients with aortic aneurysms are significantly less likely to present with rupture or to die from aneurysm rupture when compared to nondiabetic patients with aortic aneurysms. We have identified association only, not causality. However, it is plausible that DM, or the treatment of DM, may have a protective effect on aortic aneurysm rupture.
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Affiliation(s)
- Nada Selva Theivacumar
- 1Department of Vascular Surgery, King's Health Partners, King's College Hospital, Denmark Hill, London, SE5 9RS, United Kingdom
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62
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Kitagawa A, Mastracci TM, von Allmen R, Powell JT. The role of diameter versus volume as the best prognostic measurement of abdominal aortic aneurysms. J Vasc Surg 2013; 58:258-65. [DOI: 10.1016/j.jvs.2013.05.001] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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63
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Kitagawa A, Mastracci T. Part One: For the Motion. External Diameter for AAA Size. Eur J Vasc Endovasc Surg 2013; 46:1-5. [DOI: 10.1016/j.ejvs.2013.04.032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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64
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Martufi G, Auer M, Roy J, Swedenborg J, Sakalihasan N, Panuccio G, Gasser TC. Multidimensional growth measurements of abdominal aortic aneurysms. J Vasc Surg 2013; 58:748-55. [PMID: 23611712 DOI: 10.1016/j.jvs.2012.11.070] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2012] [Revised: 11/16/2012] [Accepted: 11/17/2012] [Indexed: 12/24/2022]
Abstract
BACKGROUND Monitoring the expansion of abdominal aortic aneurysms (AAAs) is critical to avoid aneurysm rupture in surveillance programs, for instance. However, measuring the change of the maximum diameter over time can only provide limited information about AAA expansion. Specifically, regions of fast diameter growth may be missed, axial growth cannot be quantified, and shape changes of potential interest for decisions related to endovascular aneurysm repair cannot be captured. METHODS This study used multiple centerline-based diameter measurements between the renal arteries and the aortic bifurcation to quantify AAA growth in 51 patients from computed tomography angiography (CTA) data. Criteria for inclusion were at least 1 year of patient follow-up and the availability of at least two sufficiently high-resolution CTA scans that allowed an accurate three-dimensional reconstruction. Consequently, 124 CTA scans were systematically analyzed by using A4clinics diagnostic software (VASCOPS GmbH, Graz, Austria), and aneurysm growth was monitored at 100 cross-sections perpendicular to the centerline. RESULTS Monitoring diameter development over the entire aneurysm revealed the sites of the fastest diameter growth, quantified the axial growth, and showed the evolution of the neck morphology over time. Monitoring the development of an aneurysm's maximum diameter or its volume over time can assess the mean diameter growth (r = 0.69, r = 0.77) but not the maximum diameter growth (r = 0.43, r = 0.34). The diameter growth measured at the site of maximum expansion was ~16%/y, almost four times larger than the mean diameter expansion of 4.4%/y. The sites at which the maximum diameter growth was recorded did not coincide with the position of the maximum baseline diameter (ρ = 0 .12; P = .31). The overall aneurysm sac length increased from 84 to 89 mm during the follow-up (P < .001), which relates to the median longitudinal growth of 3.5%/y. The neck length shortened, on average, by 6.2% per year and was accompanied by a slight increase in neck angulation. CONCLUSIONS Neither maximum diameter nor volume measurements over time are able to measure the fastest diameter growth of the aneurysm sac. Consequently, expansion-related wall weakening might be inappropriately reflected by this type of surveillance data. In contrast, localized spots of fast diameter growth can be detected through multiple centerline-based diameter measurements over the entire aneurysm sac. This information might further reinforce the quality of aneurysm surveillance programs.
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Affiliation(s)
- Giampaolo Martufi
- Department of Solid Mechanics, School of Engineering Sciences, Royal Institute of Technology, Stockholm, Sweden.
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65
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Al-Thani H, El-Menyar A, Shabana A, Tabeb A, Al-Sulaiti M, Almalki A. Incidental abdominal aneurysms: a retrospective study of 13,115 patients who underwent a computed tomography scan. Angiology 2013; 65:388-95. [PMID: 23508616 DOI: 10.1177/0003319713480554] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
We evaluated the frequency and outcomes of abdominal aortic aneurysm (AAA) in Qatar. Data were collected retrospectively between 2004 and 2008 for all adult patients who underwent abdominal computed tomographic scanning for any reason. Patients with AAA were followed up for 3 years for aneurysmal rupture and mortality. Of the 13,115 patients screened, 61 (0.5%) patients had abdominal aneurysms. Most (82%) patients with AAA were male with mean age of 67 ± 12 years. The incidence of AAA substantially increased with age. Cardiovascular risk factors were prevalent among patients with AAA. The main location of AAA was infrarenal (67%), followed by thoracoabdominal (23%). The mean AAA diameter was 5.3 ± 2.5 cm. The rate of AAA rupture was 8% with a mortality rate of 60%; 80% of these were infrarenal, and 80% of them had a diameter of ≥5.5 cm. Overall mortality was 33%. This large study addressed the impact of screening for AAA in a population with high cardiovascular burden.
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Affiliation(s)
- Hassan Al-Thani
- 1Department of Vascular Surgery, Hamad General Hospital, Doha, Qatar
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66
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Wang XL, Thompson MM, Dole WP, Dalman RL, Zalewski A. Standardization of outcome measures in clinical trials of pharmacological treatment for abdominal aortic aneurysm. Expert Rev Cardiovasc Ther 2012; 10:1251-60. [PMID: 23113642 DOI: 10.1586/erc.12.128] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
An abdominal aortic aneurysm (AAA) is a common aortic wall disease with an increased prevalence in the elderly population (4-8% for those aged >65 years). Many AAAs are slow growing and remain insidious. Current standard of care for patients with small AAAs (<49 mm) is surveillance, with interventional therapy (open surgical repair or endovascular aneurysm repair) recommended for large (>50-55 mm), rapidly growing (>10 mm/year) or symptomatic AAAs. Although open surgical repair or endovascular aneurysm repair are effective, significant short- and long-term postoperative morbidity and mortality occurs. Currently, there is no pharmacological treatment specific for AAA; the need for the development of targeted pharmacological therapies based on clinically relevant and feasible outcomes acceptable to the medical community, regulatory agencies and third-party payers is high. A consensus on such end points will be critical to accelerating the development of pharmacological agents to prevent formation, arrest the expansion and reduce the rupture risk of AAA.
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Affiliation(s)
- Xing Li Wang
- Cardiovascular Science Unit, Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA.
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67
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Sherer EA, Bies RR, Clancy P, Norman PE, Golledge J. Growth of screen-detected abdominal aortic aneurysms in men: a bayesian analysis. CPT-PHARMACOMETRICS & SYSTEMS PHARMACOLOGY 2012; 1:e12. [PMID: 23835734 PMCID: PMC3603433 DOI: 10.1038/psp.2012.13] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
There is considerable interindividual variability in the growth of abdominal aortic aneurysms (AAAs), but an individual's growth observations, risk factors, and biomarkers could potentially be used to tailor surveillance. To assess the potential for tailoring surveillance, this study determined the accuracy of individualized predictions of AAA size at the next surveillance observation. A hierarchical Bayesian model was fitted to a total of 1,732 serial ultrasound measurements from 299 men in whom ultrasound screening identified an AAA. The data were best described by a nonlinear model with a constant first derivative of the AAA growth rate with size. The area under the receiver operating characteristic (ROC) curves for predicting whether an AAA was ≥40 or ≥50 mm at the next observation were 0.922 and 0.979, respectively, and the median root mean squared error was 2.52 mm. These values were nearly identical for models with or without plasma D-dimer effects.CPT: Pharmacometrics & Systems Pharmacology (2012) 1, e12; doi:10.1038/psp.2012.13; advance online publication 24 October 2012.
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Affiliation(s)
- E A Sherer
- 1] Division of Clinical Pharmacology, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA [2] Center of Excellence on Implementing Evidence-Based Practice, Roudebush Veterans Affairs Medical Center, Indianapolis, Indiana, USA [3] Indiana Clinical and Translational Science Institute, Indianapolis, Indiana, USA
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68
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Nienaber CA. Diabetes mellitus and thoracic aortic disease: are people with diabetes mellitus protected from acute aortic dissection? J Am Heart Assoc 2012; 1:e001404. [PMID: 23130140 PMCID: PMC3487334 DOI: 10.1161/jaha.112.001404] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- Christoph A Nienaber
- Heart Center Rostock, Department of Internal Medicine I, Divisions of Cardiology, Pulmonology, and Intensive Care Medicine, University Hospital Rostock Germany
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69
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Long A, Rouet L, Lindholt J, Allaire E. Measuring the Maximum Diameter of Native Abdominal Aortic Aneurysms: Review and Critical Analysis. Eur J Vasc Endovasc Surg 2012; 43:515-24. [DOI: 10.1016/j.ejvs.2012.01.018] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2011] [Accepted: 01/18/2012] [Indexed: 12/15/2022]
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70
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Sweeting MJ, Thompson SG, Brown LC, Powell JT. Meta-analysis of individual patient data to examine factors affecting growth and rupture of small abdominal aortic aneurysms. Br J Surg 2012; 99:655-65. [DOI: 10.1002/bjs.8707] [Citation(s) in RCA: 339] [Impact Index Per Article: 28.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/19/2012] [Indexed: 11/08/2022]
Abstract
Abstract
Background
Surveillance is a common management strategy for small abdominal aortic aneurysm (AAA) (3·0–5·4 cm in diameter). Individual characteristics, other than diameter, may influence aneurysm growth or rupture rates.
Methods
Individual data were collated from 15 475 people under follow-up for a small aneurysm in 18 studies. The influence of co-variables (including demographics, medical and drug history) on aneurysm growth and rupture rates (analysed using longitudinal random-effects modelling and survival analysis with adjustment for aneurysm diameter) were summarized in an individual patient meta-analysis.
Results
The mean aneurysm growth rate of 2·21 mm/year was independent of age and sex. Growth rate was increased in smokers (by 0·35 mm/year) and decreased in patients with diabetes (by 0·51 mm/year). Mean arterial pressure had no effect and antihypertensive or other cardioprotective medications had only small, non-significant effects on aneurysm growth, consistent with the observation that calendar year of enrolment was not associated with growth rate. Rupture rates were almost fourfold higher in women than men (P < 0·001), were double in current smokers (P = 0·001) and increased with higher blood pressure (P = 0·001).
Conclusion
Follow-up schedules for individuals with a small AAA may need to consider diabetes and smoking, in addition to aneurysm diameter. The differing risk factors for growth and rupture suggest that a lower threshold for surgical intervention in women may be justified. No single drug used for cardiovascular risk reduction had a major effect on the growth or rupture of small aneurysms.
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Affiliation(s)
- M J Sweeting
- MRC Biostatistics Unit, Institute of Public Health, London, UK
| | - S G Thompson
- Department of Public Health and Primary Case, University of Cambridge, London, UK
| | - L C Brown
- Vascular Surgery Research Group, Imperial College at Charing Cross, London, UK
| | - J T Powell
- Vascular Surgery Research Group, Imperial College at Charing Cross, London, UK
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Ramos-Mozo P, Madrigal-Matute J, Vega de Ceniga M, Blanco-Colio LM, Meilhac O, Feldman L, Michel JB, Clancy P, Golledge J, Norman PE, Egido J, Martin-Ventura JL. Increased plasma levels of NGAL, a marker of neutrophil activation, in patients with abdominal aortic aneurysm. Atherosclerosis 2012; 220:552-6. [DOI: 10.1016/j.atherosclerosis.2011.11.023] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2011] [Revised: 10/26/2011] [Accepted: 11/16/2011] [Indexed: 10/15/2022]
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72
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Lederle FA. The strange relationship between diabetes and abdominal aortic aneurysm. Eur J Vasc Endovasc Surg 2012; 43:254-6. [PMID: 22237512 DOI: 10.1016/j.ejvs.2011.12.026] [Citation(s) in RCA: 73] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2011] [Accepted: 12/21/2011] [Indexed: 01/08/2023]
Abstract
In a 1997 report of a large abdominal aortic aneurysm (AAA) screening study, we observed a negative association between diabetes and AAA. Although this was not previously described and negative associations between diseases are rare, the credibility of the finding was supported by consistent results in several previous studies and by the absence of an obvious artifactual explanation. Since that time, a variety of studies of AAA diagnosis, both by screening and prospective clinical follow-up, have confirmed the finding. Other studies have reported slower aneurysm enlargement and fewer repairs for rupture in diabetics. The seeming protective effect of diabetes for AAA contrasts with its causal role in occlusive vascular disease and so provides a strong challenge to the traditional view of AAA as a manifestation of atherosclerosis. Research focused on a protective effect of diabetes has already increased our understanding of the etiology of AAA, and might eventually pave the way for new therapies to slow AAA progression.
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Affiliation(s)
- F A Lederle
- Department of Medicine (III-0), Veterans Affairs Medical Center, 1 Veterans Drive, Minneapolis, MN 55417, USA.
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73
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Roger VL, Go AS, Lloyd-Jones DM, Benjamin EJ, Berry JD, Borden WB, Bravata DM, Dai S, Ford ES, Fox CS, Fullerton HJ, Gillespie C, Hailpern SM, Heit JA, Howard VJ, Kissela BM, Kittner SJ, Lackland DT, Lichtman JH, Lisabeth LD, Makuc DM, Marcus GM, Marelli A, Matchar DB, Moy CS, Mozaffarian D, Mussolino ME, Nichol G, Paynter NP, Soliman EZ, Sorlie PD, Sotoodehnia N, Turan TN, Virani SS, Wong ND, Woo D, Turner MB. Heart disease and stroke statistics--2012 update: a report from the American Heart Association. Circulation 2012; 125:e2-e220. [PMID: 22179539 PMCID: PMC4440543 DOI: 10.1161/cir.0b013e31823ac046] [Citation(s) in RCA: 3169] [Impact Index Per Article: 264.1] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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74
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Badger SA, Jones C, McClements J, Lau LL, Young IS, Patterson CC. Surveillance strategies according to the rate of growth of small abdominal aortic aneurysms. Vasc Med 2011; 16:415-21. [DOI: 10.1177/1358863x11423971] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The management of small abdominal aortic aneurysms (AAA) is by ultrasound surveillance. The study aimed to calculate their growth rate, identify risk factors and determine appropriate screening intervals. The local screening programme and hospital records were used to identify patients with a small (< 5.5 cm) AAA. The dates and maximum diameter of serial scans of patients with two or more scans were obtained. Patients were subdivided by 0.5 cm increments above 3.0 cm. The rate of growth was calculated by linear regression for each patient using both the absolute measurements and logarithmically (ln) transformed measurements. The 95th centile of growth rate within each subgroup was used to estimate the minimum time to grow to 5.5 cm. A total of 252 were included. The mean (± SD) AAA size on the initial scan was 3.9 (± 0.7) cm. Statin use and initial size were predictive factors for the growth rate. The median rate of growth increased according to size from 0.075 to 0.432 cm/year for AAA < 3.5 cm and > 5.0 cm, respectively. It also steadily increased for ln measurements from 0.022 (or 2.2%/year) to 0.078 or (7.8%/year). The minimum time (months) to reach 5.5 cm was 61, 17, 11 and 5 for AAA < 3.5 cm, 3.5–3.9 cm, 4.0–4.4 cm and 4.5–4.9 cm, respectively. Based on ln measurements, the times were similar at 60, 17, 10 and 4 months. In conclusion, the rate of growth increased steadily with AAA size. An aneurysm < 3.5 cm does not require a repeat scan for 5 years, while those measuring 3.5–3.9 cm and 4.0–4.4 cm require a repeat scan after 17 and 11 months.
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Affiliation(s)
- Stephen A Badger
- Vascular and Endovascular Surgery Department, Belfast City Hospital, Belfast, UK
| | - Claire Jones
- Vascular and Endovascular Surgery Department, Belfast City Hospital, Belfast, UK
| | - Jane McClements
- Vascular and Endovascular Surgery Department, Belfast City Hospital, Belfast, UK
| | - Louis L Lau
- Vascular and Endovascular Surgery Department, Belfast City Hospital, Belfast, UK
| | - Ian S Young
- Centre for Public Health, Queens University Belfast, Belfast, UK
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75
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Moxon JV, Parr A, Emeto TI, Walker P, Norman PE, Golledge J. Diagnosis and monitoring of abdominal aortic aneurysm: current status and future prospects. Curr Probl Cardiol 2011; 35:512-48. [PMID: 20932435 DOI: 10.1016/j.cpcardiol.2010.08.004] [Citation(s) in RCA: 100] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abdominal aortic aneurysm (AAA) remains an important cause of morbidity and mortality in elderly men, and prevalence is predicted to increase in parallel with a global aging population. AAA is commonly asymptomatic, and in the absence of routine screening, diagnosis is usually incidental when imaging to assess unrelated medical complaints. In the absence of approved diagnostic and prognostic markers, AAAs are monitored conservatively via medical imaging until aortic diameter approaches 50-55 mm and surgical repair is performed. There is currently significant interest in identifying molecular markers of diagnostic and prognostic value for AAA. Here we outline the current guidelines for AAA management and discuss modern scientific techniques currently employed to identify improved diagnostic and prognostic markers.
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76
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Georgakarakos E, Ioannou CV, Georgiadis GS, Kapoulas K, Schoretsanitis N, Lazarides M. Expanding Current EVAR Indications to Include Small Abdominal Aortic Aneurysms: A Glimpse of the Future. Angiology 2011; 62:500-3. [DOI: 10.1177/0003319711398651] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The traditional criterion of maximum transverse diameter is not sufficient to differentiate the small abdominal aortic aneurysms (AAAs) that are either prone to rupture or prone to enlarge rapidly. Wall stress may be a more reliable indicator with respect to these tasks. We review the importance of geometric features in rupture- or growth-predictive models and stress the need for further evaluation and validation of geometric indices. This study may lead to identifying those small AAAs that could justify early endovascular intervention.
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Affiliation(s)
- Efstratios Georgakarakos
- Department of Vascular Surgery, “Demokritos” University of Thrace, University Hospital of Alexandroupolis, Greece,
| | - Christos V. Ioannou
- Department of Vascular Surgery, University of Crete, University Hospital of Heraklion, Greece
| | - George S. Georgiadis
- Department of Vascular Surgery, “Demokritos” University of Thrace, University Hospital of Alexandroupolis, Greece
| | - Konstantinos Kapoulas
- Department of Vascular Surgery, “Demokritos” University of Thrace, University Hospital of Alexandroupolis, Greece
| | - Nikolaos Schoretsanitis
- Department of Vascular Surgery, “Demokritos” University of Thrace, University Hospital of Alexandroupolis, Greece
| | - Miltos Lazarides
- Department of Vascular Surgery, “Demokritos” University of Thrace, University Hospital of Alexandroupolis, Greece
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77
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Powell JT, Sweeting MJ, Brown LC, Gotensparre SM, Fowkes FG, Thompson SG. Systematic review and meta-analysis of growth rates of small abdominal aortic aneurysms. Br J Surg 2011; 98:609-18. [PMID: 21412998 DOI: 10.1002/bjs.7465] [Citation(s) in RCA: 67] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/12/2011] [Indexed: 11/05/2022]
Abstract
BACKGROUND Small abdominal aortic aneurysms are usually asymptomatic and managed safely in ultrasound surveillance programmes until they grow to a diameter threshold where intervention is considered. The aim of this study was to synthesize systematically the published data on growth rates for small aneurysms to investigate the evidence basis for surveillance intervals. METHODS This was a systematic review of the literature published before January 2010, which identified 61 potentially eligible reports. Detailed review yielded 15 studies providing growth rates for aneurysms 3·0-5·5 cm in diameter (14 in millimetres per year, 1 as percentage change per year). These studies included 7630 people (predominantly men) enrolled during 1976-2005. RESULTS The pooled mean growth rate was 2·32 (95 per cent confidence interval 1·95 to 2·70) mm/year but there was very high heterogeneity between studies; the growth rate ranged from - 0·33 to + 3·95 mm/year. Six studies reported growth rates by 5-mm diameter bands, which showed the trend for growth rate to increase with aneurysm diameter. Simple methods to determine growth rate were associated with higher estimates. Meta-regression analysis showed that a 10-mm increase in aneurysm diameter was associated with a mean(s.e.m.) 1·62(0·20) mm/year increase in growth rate. Neither mean age nor percentage of women in each study had a significant effect. On average, a 3·5-cm aneurysm would take 6·2 years to reach 5·5 cm, whereas a 4·5-cm aneurysm would take only 2·3 years. CONCLUSION There was considerable variation in the reported growth rates of small aneurysms beyond that explained by aneurysm diameter. Fuller evidence on which to base surveillance intervals for patients in screening programmes requires a meta-analysis based on individual patient data.
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Affiliation(s)
- J T Powell
- Vascular Surgery Research Group, Imperial College London, Charing Cross Campus, London, UK.
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78
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Roger VL, Go AS, Lloyd-Jones DM, Adams RJ, Berry JD, Brown TM, Carnethon MR, Dai S, de Simone G, Ford ES, Fox CS, Fullerton HJ, Gillespie C, Greenlund KJ, Hailpern SM, Heit JA, Ho PM, Howard VJ, Kissela BM, Kittner SJ, Lackland DT, Lichtman JH, Lisabeth LD, Makuc DM, Marcus GM, Marelli A, Matchar DB, McDermott MM, Meigs JB, Moy CS, Mozaffarian D, Mussolino ME, Nichol G, Paynter NP, Rosamond WD, Sorlie PD, Stafford RS, Turan TN, Turner MB, Wong ND, Wylie-Rosett J. Heart disease and stroke statistics--2011 update: a report from the American Heart Association. Circulation 2011; 123:e18-e209. [PMID: 21160056 PMCID: PMC4418670 DOI: 10.1161/cir.0b013e3182009701] [Citation(s) in RCA: 3661] [Impact Index Per Article: 281.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Each year, the American Heart Association (AHA), in conjunction with the Centers for Disease Control and Prevention, the National Institutes of Health, and other government agencies, brings together the most up-to-date statistics on heart disease, stroke, other vascular diseases, and their risk factors and presents them in its Heart Disease and Stroke Statistical Update. The Statistical Update is a valuable resource for researchers, clinicians, healthcare policy makers, media professionals, the lay public, and many others who seek the best national data available on disease morbidity and mortality and the risks, quality of care, medical procedures and operations, and costs associated with the management of these diseases in a single document. Indeed, since 1999, the Statistical Update has been cited more than 8700 times in the literature (including citations of all annual versions). In 2009 alone, the various Statistical Updates were cited ≈1600 times (data from ISI Web of Science). In recent years, the Statistical Update has undergone some major changes with the addition of new chapters and major updates across multiple areas. For this year’s edition, the Statistics Committee, which produces the document for the AHA, updated all of the current chapters with the most recent nationally representative data and inclusion of relevant articles from the literature over the past year and added a new chapter detailing how family history and genetics play a role in cardiovascular disease (CVD) risk. Also, the 2011 Statistical Update is a major source for monitoring both cardiovascular health and disease in the population, with a focus on progress toward achievement of the AHA’s 2020 Impact Goals. Below are a few highlights from this year’s Update.
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79
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Parr A, McCann M, Bradshaw B, Shahzad A, Buttner P, Golledge J. Thrombus volume is associated with cardiovascular events and aneurysm growth in patients who have abdominal aortic aneurysms. J Vasc Surg 2011; 53:28-35. [PMID: 20934838 DOI: 10.1016/j.jvs.2010.08.013] [Citation(s) in RCA: 115] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2010] [Revised: 07/27/2010] [Accepted: 08/04/2010] [Indexed: 11/29/2022]
Abstract
BACKGROUND Patients with abdominal aortic aneurysms (AAA) are predisposed to cardiovascular events and often experience continual expansion of their aneurysm. Cardiovascular events and expansion rates are positively correlated with aneurysm size. AAA is usually associated with intraluminal thrombus, which has previously been implicated in AAA pathogenesis. This study prospectively assessed the association of infrarenal abdominal aortic thrombus volume with cardiovascular events and AAA growth. METHODS Ninety-eight patients with AAAs underwent computed tomography angiography (CTA). The volume of infrarenal aorta thrombus was measured by a previously validated technique. Patients were monitored prospectively for a median of 3 years (interquartile range [IQR], 2.0-3.6 years), and cardiovascular events (nonfatal stroke, nonfatal myocardial infarction, coronary revascularization, amputation, and cardiovascular death) were recorded. Of the original patients, 39 underwent repeat CTA a median of 1.5 years (IQR, 1.1-3.3 years) after entry to the study. Kaplan-Meier and Cox proportional analysis were used to examine the association of aortic thrombus with cardiovascular events and average weighted AAA growth. RESULTS There were 28 cardiovascular events during follow-up. The incidence of cardiovascular events was 23.4% and 49.2% for patients with small (smaller than the median) and large (median or larger) volumes of aortic thrombus, respectively, at 4 years (P = .040). AAA thrombus volume of median or larger was associated with increased cardiovascular events (relative risk [RR] 2.8, 95% confidence interval [CI], 1.01-5.24) independent of other risk factors, including initial AAA diameter, but was only of borderline significance when patients were censored at the time of AAA repair (RR, 2.35; 95% CI, 0.98-5.63). In the subset of patients with CTA follow-up, the median annual increase in AAA volume was 5.1 cm³ (IQR, 0.8-10.3 cm³). Annual AAA volume increase was positively correlated with initial AAA diameter (r = 0.44, P = .006) and thrombus volume (r = 0.50, P = .001). Median or larger aortic thrombus volume was associated with rapid AAA volume increase (≥ 5 cm/y), independent of initial aortic diameter (RR, 15.0; 95% CI, 1.9-115.7; P = .009). CONCLUSION In this small cohort, infrarenal aortic thrombus volume was associated with the incidence of cardiovascular events and AAA progression. These results need to be confirmed and mechanisms underlying the associations clarified in large further studies.
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Affiliation(s)
- Adam Parr
- Vascular Biology Unit, James Cook University, Townsville, Queensland, Australia
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80
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Moll FL, Powell JT, Fraedrich G, Verzini F, Haulon S, Waltham M, van Herwaarden JA, Holt PJE, van Keulen JW, Rantner B, Schlösser FJV, Setacci F, Ricco JB. 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. [PMID: 21215940 DOI: 10.1016/j.ejvs.2010.09.011] [Citation(s) in RCA: 996] [Impact Index Per Article: 76.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2010] [Accepted: 09/12/2010] [Indexed: 12/11/2022]
Affiliation(s)
- F L Moll
- Department of Vascular Surgery, University Medical Center Utrecht, The Netherlands.
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81
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Sena Ruiz F, Lozano Vilardell P, Merino Mairal O, Riera Vázquez R. Evolución del diámetro iliaco tras resección de aneurisma aórtico e interposición de injerto aorto-aórtico. ANGIOLOGIA 2010. [DOI: 10.1016/s0003-3170(10)70052-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
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82
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Powell JT, Gotensparre SM, Sweeting MJ, Brown LC, Fowkes FGR, Thompson SG. Rupture rates of small abdominal aortic aneurysms: a systematic review of the literature. Eur J Vasc Endovasc Surg 2010; 41:2-10. [PMID: 20952216 DOI: 10.1016/j.ejvs.2010.09.005] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2010] [Accepted: 09/01/2010] [Indexed: 12/26/2022]
Abstract
BACKGROUND Small aneurysms of the abdominal aorta (3.0-5.5 cm in diameter) often are managed by regular surveillance, rather than surgery, because the risk of surgery is considered to outweigh the risk of aneurysm rupture. The risk of small aneurysm rupture is considered to be low. The purpose of this review is to summarise the reported estimates of small aneurysm rupture rates. METHODS AND FINDINGS We conducted a systematic review of the literature published before 2010 and identified 54 potentially eligible reports. Detailed review of these studies showed that both ascertainment of rupture, patient follow-up and causes of death were poorly reported: diagnostic criteria for rupture were never reported. There were only 14 studies from which rupture rates (as ruptures per 100 person-years) were available. These 14 published studies included 9779 patients (89% male) over the time period 1976-2006 but only 7 of these studies provided rupture rates specifically for the diameter range 3.0-5.5 cm, which ranged from 0 to 1.61 ruptures per 100 person-years. CONCLUSIONS Rupture rates of small abdominal aortic aneurysms would appear to be low, but most studies have been poorly reported and did not have clear ascertainment and diagnostic criteria for aneurysm rupture.
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Affiliation(s)
- J T Powell
- Vascular Surgery Research Group, Imperial College London, Charing Cross Campus, St Dunstan's Road, London W6 8RP, UK.
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83
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Sweeting MJ, Thompson SG, Brown LC, Greenhalgh RM, Powell JT. Use of angiotensin converting enzyme inhibitors is associated with increased growth rate of abdominal aortic aneurysms. J Vasc Surg 2010; 52:1-4. [DOI: 10.1016/j.jvs.2010.02.264] [Citation(s) in RCA: 87] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2009] [Revised: 02/19/2010] [Accepted: 02/23/2010] [Indexed: 10/19/2022]
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84
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Thompson A, Cooper JA, Fabricius M, Humphries SE, Ashton HA, Hafez H. An analysis of drug modulation of abdominal aortic aneurysm growth through 25 years of surveillance. J Vasc Surg 2010; 52:55-61.e2. [DOI: 10.1016/j.jvs.2010.02.012] [Citation(s) in RCA: 91] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2009] [Revised: 02/02/2010] [Accepted: 02/03/2010] [Indexed: 10/19/2022]
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85
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Conway BD, Greenberg RK, Mastracci TM, Hernandez AV, Coscas R. Renal Artery Implantation Angles in Thoracoabdominal Aneurysms and Their Implications in the Era of Branched Endografts. J Endovasc Ther 2010; 17:380-7. [DOI: 10.1583/10-3038.1] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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86
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Speelman L, Hellenthal F, Pulinx B, Bosboom E, Breeuwer M, van Sambeek M, van de Vosse F, Jacobs M, Wodzig W, Schurink G. The Influence of Wall Stress on AAA Growth and Biomarkers. Eur J Vasc Endovasc Surg 2010; 39:410-6. [DOI: 10.1016/j.ejvs.2009.12.021] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2009] [Accepted: 12/19/2009] [Indexed: 10/20/2022]
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87
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Solberg S, Forsdahl S, Singh K, Jacobsen B. Diameter of the Infrarenal Aorta as a Risk Factor for Abdominal Aortic Aneurysm: The Tromsø Study, 1994–2001. Eur J Vasc Endovasc Surg 2010; 39:280-4. [DOI: 10.1016/j.ejvs.2009.10.017] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2009] [Accepted: 10/31/2009] [Indexed: 10/20/2022]
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88
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Lloyd-Jones D, Adams RJ, Brown TM, Carnethon M, Dai S, De Simone G, Ferguson TB, Ford E, Furie K, Gillespie C, Go A, Greenlund K, Haase N, Hailpern S, Ho PM, Howard V, Kissela B, Kittner S, Lackland D, Lisabeth L, Marelli A, McDermott MM, Meigs J, Mozaffarian D, Mussolino M, Nichol G, Roger VL, Rosamond W, Sacco R, Sorlie P, Roger VL, Thom T, Wasserthiel-Smoller S, Wong ND, Wylie-Rosett J. Heart Disease and Stroke Statistics—2010 Update. Circulation 2010; 121:e46-e215. [PMID: 20019324 DOI: 10.1161/circulationaha.109.192667] [Citation(s) in RCA: 2601] [Impact Index Per Article: 185.8] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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89
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Magee R, Quigley F, McCann M, Buttner P, Golledge J. Growth and risk factors for expansion of dilated popliteal arteries. Eur J Vasc Endovasc Surg 2010; 39:606-11. [PMID: 20122854 DOI: 10.1016/j.ejvs.2009.12.031] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2009] [Accepted: 12/25/2009] [Indexed: 12/11/2022]
Abstract
OBJECTIVES The aims of this study were to investigate the change in maximum diameter of ectatic popliteal arteries during ultrasound surveillance and assess clinical predictors of their expansion. METHODS Over a ten year period 67 patients with ectasia affecting one (n = 1) or both (n = 66) popliteal arteries entered this surveillance study. Patients were followed for a median of 3.1 years, at a median scan interval of 7.6 months. RESULTS Growth of ectatic popliteal arteries was typically slow (<1 mm/yr). Initial artery diameter at entry to the study was not found to be predictive of subsequent growth. Seven patients followed for a median of 2 years had an expansion in popliteal artery diameter to >or=20 mm during follow-up. All of these patients had undergone aneurysm repairs at other arterial sites and none of them had diabetes. These participants also had a significantly higher rate of previous intervention of the contralateral popliteal artery in comparison to those that did not reach the 20 mm threshold (p < 0.001). Growth profiles of arteries that underwent significant expansion during surveillance were frequently characterised by a staccato pattern. CONCLUSIONS Expansion of ectatic popliteal arteries is typically slow but difficult to predict. Trends observed in this study suggest that patients with extra-popliteal aneurysms, patients with previously treated contralateral popliteal artery ectasia and those who are not diabetics may be more prone to significant expansion. Further studies are required to validate these potential growth predictors.
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Affiliation(s)
- R Magee
- Department of Vascular Surgery, The Townsville Hospital, Townsville, Australia
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90
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Thompson AR, Cooper JA, Ashton HA, Hafez H. Growth rates of small abdominal aortic aneurysms correlate with clinical events. Br J Surg 2009; 97:37-44. [PMID: 20013940 DOI: 10.1002/bjs.6779] [Citation(s) in RCA: 76] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Abstract
Background
This retrospective analysis of prospectively collected abdominal aortic aneurysm (AAA) screening data aimed to identify predictors of AAA-related events (surgery or death) with a view to better targeting of screening.
Methods
For the interval 1984–2007, data for 1649 subjects with an AAA were collected prospectively as part of the Chichester AAA screening programme. This included serial aortic size measurements, blood pressure, risk factors for arterial disease and concurrent medications. AAA growth rates were adjusted for risk factor confounders using flexible hierarchical modelling. AAA growth distribution was analysed using Silverman's test of multimodality.
Results
Some 1231 subjects met the inclusion criteria of having more than one scan and a surveillance interval of over 3 months. AAA growth showed a bimodal pattern with nearly 50 per cent of all aneurysms never progressing to surgery or rupture. Adjusted annual AAA growth rates of at least 2 mm significantly predicted AAA-related events.
Conclusion
This analysis identified a bimodal growth pattern for AAA, with a significant association between annual AAA growth rate of at least 2 mm and AAA-related events.
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Affiliation(s)
- A R Thompson
- Department of Vascular Surgery, Western Sussex Hospital NHS Trust, Chichester, UK
- Centre for Cardiovascular Genetics, British Heart Foundation Laboratories, University College London, London, UK
| | - J A Cooper
- Centre for Cardiovascular Genetics, British Heart Foundation Laboratories, University College London, London, UK
| | - H A Ashton
- Department of Vascular Surgery, Western Sussex Hospital NHS Trust, Chichester, UK
| | - H Hafez
- Department of Vascular Surgery, Western Sussex Hospital NHS Trust, Chichester, UK
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92
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Vega-De Céniga M, Esteban-Salan M, Quintana-López J, Barba-Vélez A, Estallo-Laliena L, de la Fuente-Sánchez N, Viviens-Redondo B, García-Gutiérrez S, Aguirre-Larracoechea U. Evaluación de la proteína C reactiva, alfa1-antitripsina y lipoproteína(a) como potenciales marcadores biológicos asociados al crecimiento del aneurisma de aorta abdominal. ANGIOLOGIA 2009. [DOI: 10.1016/s0003-3170(09)13002-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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93
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Schlösser FJV, Tangelder MJD, Verhagen HJM, van der Heijden GJMG, Muhs BE, van der Graaf Y, Moll FL. Growth predictors and prognosis of small abdominal aortic aneurysms. J Vasc Surg 2008; 47:1127-33. [PMID: 18440183 DOI: 10.1016/j.jvs.2008.01.041] [Citation(s) in RCA: 102] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2007] [Revised: 01/13/2008] [Accepted: 01/13/2008] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Evidence regarding the influence of cardiovascular risk factors, comorbidities, and patient characteristics on the growth of small abdominal aortic aneurysms (AAA) is limited. We assessed, in an observational cohort study, rupture rates, risks of mortality, and the effects of cardiovascular risk factors and patient demographics on growth rates of small AAAs. METHODS Between September 1996 and January 2005, 5057 patients with manifest arterial vascular disease or cardiovascular risk factors were included in the Second Manifestation of ARTerial disease (SMART) study. Measurements of the abdominal aortic diameter were performed in all patients. All patients with an initial AAA diameter between 30 and 55 mm were selected for this study. All AAA measurements during follow-up until August 2007 were collected. Multivariate regression analysis was performed to calculate the effects of demographic patient characteristics, initial AAA diameter, and cardiovascular risk factors on AAA growth. RESULTS Included were 230 patients, with a mean age of 66 years and 90% were male. Seven AAA ruptures (six fatal) occurred in 755 patient years of follow-up (rupture rate 0.9% per patient-year). In 147 patients, AAA measurements were performed for a period of more than 6 months. The median follow-up time was 3.3 years (mean 4.0, range 0.5 to 11.1 years, standard deviation (SD) 2.5). Mean AAA diameter was 38.8 mm (SD 6.8) and mean expansion rate 2.5 mm/y. Patients using lipid-lowering drugs had a 1.2 mm/y (95% confidence interval [CI] -2.34 to -0.060 mm/y) lower AAA growth rate compared to nonusers of these drugs. Initial AAA diameter was associated with a 0.09 mm/y (95% CI 0.01 to 0.18 mm/y) higher growth rate per millimetre increase of the diameter. No other factors, including blood lipid values, were independently associated with AAA growth. CONCLUSIONS Lipid-lowering drug treatment and initial AAA diameter appear to be independently associated with lower AAA growth rates. The risk of rupture of these small abdominal aortic aneurysms was low, which pleads for watchful waiting.
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Affiliation(s)
- Felix J V Schlösser
- Department of Vascular Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
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94
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Sahal M, Prusa A, Wibmer A, Wolff K, Lammer J, Polterauer P, Kretschmer G, Teufelsbauer H. Elective Abdominal Aortic Aneurysm Repair: Does the Aneurysm Diameter Influence Long-Term Survival? Eur J Vasc Endovasc Surg 2008; 35:288-94. [DOI: 10.1016/j.ejvs.2007.09.019] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2007] [Accepted: 09/25/2007] [Indexed: 10/22/2022]
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95
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Freiberg MS, Arnold AM, Newman AB, Edwards MS, Kraemer KL, Kuller LH. Abdominal Aortic Aneurysms, Increasing Infrarenal Aortic Diameter, and Risk of Total Mortality and Incident Cardiovascular Disease Events. Circulation 2008; 117:1010-7. [DOI: 10.1161/circulationaha.107.720219] [Citation(s) in RCA: 94] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background—
Long-term data describing small abdominal aortic aneurysms (AAAs) and increasing infrarenal aortic diameters and their relationship to future surgical repair, total mortality, and incident cardiovascular disease (CVD) events, particularly among women, are sparse.
Methods and Results—
In 1992 to 1993, 4734 Cardiovascular Health Study participants ≥65 years old had an abdominal aortic ultrasound evaluation. Of those screened, 416 had an AAA (infrarenal aortic diameter ≥3.0 cm or an infrarenal/suprarenal ratio ≥1.2). By 2002, there were 56 surgical AAA repairs and 10 AAA-related deaths. A single ultrasound screening demonstrated that aneurysm dilation ≥3 cm identified 68% of all AAA repairs over the next 10 years and 6 of the 10 AAA-related deaths in 4% of the total population and that a ≥2.5-cm dilation identified 91% of all AAA repairs and 9 of the 10 deaths in 10% of the total population. With adjusted Cox proportional hazard models, AAAs were associated with a higher risk of total mortality (hazard ratio 1.44, 95% confidence interval 1.25 to 1.66) and incident CVD events (hazard ratio 1.52, 95% confidence interval 1.25 to 1.85). Compared with diameters <2.0 cm, infrarenal aortic diameters 2.0 to <3.0 cm were associated with increased risk of incident CVD events in women and total mortality in men.
Conclusions—
This study suggests that a 1-time screening of the abdominal aorta can acceptably identify individuals with a clinically significant AAA. Infrarenal aortic diameters >2.0 cm are associated with a significantly increased risk of future CVD events and total mortality.
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Affiliation(s)
- Matthew S. Freiberg
- From the University of Pittsburgh (M.S.F., A.B.N., K.L.K., L.H.K.), Pittsburgh, Pa; University of Washington (A.M.A.), Seattle, Wash; and Wake Forest University (M.S.E.), Winston-Salem, NC
| | - Alice M. Arnold
- From the University of Pittsburgh (M.S.F., A.B.N., K.L.K., L.H.K.), Pittsburgh, Pa; University of Washington (A.M.A.), Seattle, Wash; and Wake Forest University (M.S.E.), Winston-Salem, NC
| | - Anne B. Newman
- From the University of Pittsburgh (M.S.F., A.B.N., K.L.K., L.H.K.), Pittsburgh, Pa; University of Washington (A.M.A.), Seattle, Wash; and Wake Forest University (M.S.E.), Winston-Salem, NC
| | - Matthew S. Edwards
- From the University of Pittsburgh (M.S.F., A.B.N., K.L.K., L.H.K.), Pittsburgh, Pa; University of Washington (A.M.A.), Seattle, Wash; and Wake Forest University (M.S.E.), Winston-Salem, NC
| | - Kevin L. Kraemer
- From the University of Pittsburgh (M.S.F., A.B.N., K.L.K., L.H.K.), Pittsburgh, Pa; University of Washington (A.M.A.), Seattle, Wash; and Wake Forest University (M.S.E.), Winston-Salem, NC
| | - Lewis H. Kuller
- From the University of Pittsburgh (M.S.F., A.B.N., K.L.K., L.H.K.), Pittsburgh, Pa; University of Washington (A.M.A.), Seattle, Wash; and Wake Forest University (M.S.E.), Winston-Salem, NC
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96
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De Rango P, Cao P, Parlani G, Verzini F, Brambilla D. Outcome after endografting in small and large abdominal aortic aneurysms: a metanalysis. Eur J Vasc Endovasc Surg 2008; 35:162-72. [PMID: 18069023 DOI: 10.1016/j.ejvs.2007.10.015] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2007] [Accepted: 10/17/2007] [Indexed: 10/22/2022]
Abstract
AIM To compare the results of endovascular repair (EVAR) in large and small (diameter < 5.5cm) abdominal aortic aneurysms (AAA). METHODS A systematic review was performed to identify studies comparing the outcomes after EVAR of large and small aneurysms. Outcomes considered were: risk of death (perioperative, all cause, aneurysm-related), ruptures, and complications (conversion, reintervention). Weighted pooled estimates of outcomes in patients with small versus large aneurysms were calculated. The inverse variance method was used (random-effect model). Subgroup analyses by a follow-up longer or shorter than 24 months were performed. RESULTS Five studies, with published and unpublished data, totallying 7,735 patients, were included. Overall, the weighted pooled estimates were: OR 0.68; 95% CI 0.51-0.90 for operative mortality, OR 0.77; 95% CI 0.69 to 0.86 for all cause mortality, OR 0.58; 95% CI 0.40 to 0.87 for aneurysm-related mortality and OR 0.61; 95% CI 0.47 to 0.79 for rupture in favour of small AAA group. Pooled estimates were not influenced by follow-up length. Conversion and reintervention rates were not significantly lower for small AAA. CONCLUSIONS EVAR in small versus large AAA might be associated with lower operative mortality, aneurysm-related mortality and aneurysm rupture. Better evidence is needed to support these suggestions.
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Affiliation(s)
- P De Rango
- Division of Vascular and Endovascular Surgery, University of Perugia, Ospedale S. Maria della Misericordia, Perugia, Italy
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Vega de Céniga M, Gómez R, Estallo L, de la Fuente N, Viviens B, Barba A. Analysis of Expansion Patterns in 4-4.9 cm Abdominal Aortic Aneurysms. Ann Vasc Surg 2008; 22:37-44. [PMID: 18083334 DOI: 10.1016/j.avsg.2007.07.036] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2007] [Revised: 07/19/2007] [Accepted: 07/23/2007] [Indexed: 12/30/2022]
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98
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100
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Novel insight into the pathobiology of abdominal aortic aneurysm and potential future treatment concepts. Prog Cardiovasc Dis 2007; 50:209-17. [PMID: 17976505 DOI: 10.1016/j.pcad.2007.05.001] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
The patient with abdominal aortic aneurysm (AAA) commonly is a nondiabetic, white man with a history of smoking. Moreover, AAA represents a leading cause of death in elderly men in Western countries. The purpose of this manuscript is to review current evidence as to the pathobiology of AAA as well as potential future drug targets to prevent progression of AAA.
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