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Abstract
Background To date, our understanding of the global aortic aneurysm (AA) burden distribution is very limited. Objective To assess a full view of global AA burden distribution and attributable risk factors from 1990 to 2017. Methods We extracted data of AA deaths, disability-adjusted life years (DALYs), and their corresponding age-standardized rates (ASRs), in general and by age/sex from the 2017 Global Burden of Disease (GBD) study. The current AA burden distribution in 2017 and its changing trend from 1990 to 2017 were separately showed. The spatial divergence was discussed from four levels: global, five social-demographic index regions, 21 GBD regions, and 195 countries and territories. We also estimated the risk factors attributable to AA related deaths. Results Globally, the AA deaths were 167,249 with an age-standardized death rate (ASDR) of 2.19/100,000 persons in 2017, among which the elderly and the males accounted for the majority. Although reductions in ASRs were observed in developed areas, AA remained an important health issue in those relatively underdeveloped areas and might be much more important in the near future. AA may increasingly affect the elderly and the female population. Similar patterns of AA DALYs burden were noted during the study period. AA burden attributable to high blood pressure and smoking decreased globally and there were many heterogeneities in their distribution. Discussion AA maintained an incremental public health issue worldwide. The change pattern of AA burden was heterogeneous across locations, ages, and sexes and it is paramount to improve resource allocation for more effective and targeted prevention strategies. Also, prevention of tobacco consumption and blood pressure control should be emphasized.
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152
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Jeeji AK, Ekstein SF, Ifelayo OI, Oyemade KA, Tawfic SS, Hyde RJ, Laughlin MJ, Lohse CM, Mullan AF, Kummer T, Bellamkonda VR. Increased body mass index is associated with decreased imaging quality of point-of-care abdominal aortic ultrasonography. JOURNAL OF CLINICAL ULTRASOUND : JCU 2021; 49:328-333. [PMID: 32984964 DOI: 10.1002/jcu.22929] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 09/06/2020] [Accepted: 09/16/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Given that abdominal aorta is a retroperitoneal structure, increased body mass index (BMI) may have an adverse effect upon the quality of aortic ultrasonographic imaging. PURPOSE To assess the hypothesis that increased BMI is associated with worsening point-of-care abdominal aortic ultrasonographic image quality. METHODS This is a retrospective single-center study of point-of-care abdominal aortic ultrasound examinations performed in an academic emergency department (ED) with fellowship-trained emergency ultrasonography faculty performing quality assurance review. RESULTS Mean ± SD BMI was 27.4 ± 6.2, among the 221 included records. The overall quality rating decreased as BMI increased (correlation coefficient - 0.24; P < .001) and this persisted after adjustment for age and sex (P < .001). Although BMI was higher on average in the records that were of insufficient quality for clinical decisions when compared with those of sufficient quality (mean BMI 28.7 vs 27.0), this did not reach statistical significance in a univariable setting (P = .11) or after adjusting for age and sex (P = .14). CONCLUSION This study data shows a decrease in point-of-care abdominal aorta ultrasound imaging quality as BMI increases, though this difference did not result in a statistically significant impairment in achieving the minimum quality for clinical decisions. This finding may help ameliorate some clinician concerns about ultrasonography for patients with high BMI.
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Affiliation(s)
- Archana K Jeeji
- Mayo Clinic Alix School of Medicine, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA
| | - Samuel F Ekstein
- Mayo Clinic Alix School of Medicine, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA
| | - Oluwatomilona I Ifelayo
- Mayo Clinic Alix School of Medicine, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA
| | - Kafayat A Oyemade
- Mayo Clinic Alix School of Medicine, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA
| | - Sarah S Tawfic
- Mayo Clinic Alix School of Medicine, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA
| | - Robert J Hyde
- Department of Emergency Medicine, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA
| | - Michael J Laughlin
- Department of Emergency Medicine, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA
| | - Christine M Lohse
- Department of Biostatistics and Informatics, Mayo Clinic, Rochester, Minnesota, USA
| | - Aidan F Mullan
- Department of Biostatistics and Informatics, Mayo Clinic, Rochester, Minnesota, USA
| | - Tobias Kummer
- Department of Emergency Medicine, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA
| | - Venkatesh R Bellamkonda
- Department of Emergency Medicine, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA
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153
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Walsh ME, Jameson J. Review of article: Extended screening guidelines for the diagnosis of abdominal aortic aneurysm. Carnevale ML, Koleilat I, Lipsitz EC, Friedmann P, and Indes JE. J Vasc Surg 2020;72:1917-26. JOURNAL OF VASCULAR NURSING 2021; 39:17-18. [PMID: 33894948 DOI: 10.1016/j.jvn.2021.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- M Eileen Walsh
- University of Toledo, College of Nursing, 3000 Arlington Avenue, Mail stop #1026, Toledo, OH 43614-2598, United States.
| | - Jodi Jameson
- University of Toledo, College of Nursing, 3000 Arlington Avenue, Mail stop #1026, Toledo, OH 43614-2598, United States
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154
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Gallego-Colon E, Yosefy C, Cherniavsky E, Osherov A, Khalameizer V, Piltz X, Pery M, Bruoha S, Jafari J. Isolated ascending aorta dilatation is associated with increased risk of abdominal aortic aneurysm. J Cardiothorac Surg 2021; 16:108. [PMID: 33892751 PMCID: PMC8063334 DOI: 10.1186/s13019-021-01488-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Accepted: 04/06/2021] [Indexed: 11/10/2022] Open
Abstract
Background Abdominal aortic aneurysm (AAA) is an asymptomatic condition characterized by progressive dilatation of the aorta. The purpose of this study is to identify important 2D-TTE aortic indices associated with AAA as predictive tools for undiagnosed AAA. Methods In this retrospective study, we evaluated the size of the ascending aorta in patients without known valvular diseases or hemodynamic compromise as predictive tool for undiagnosed AAA. We studied the tubular ascending aorta of 170 patients by 2-dimensional transthoracic echocardiography (2D-TTE). Patients were further divided into two groups, 70 patients with AAA and 100 patients without AAA with normal imaging results. Results Dilatation of tubular ascending aorta was measured in patients with AAA compared to the group with absent AAA (37.5 ± 4.8 mm vs. 31.2 ± 3.6 mm, p < 0.001, respectively) and confirmed by computed tomographic (CT) (35.6 ± 5.1 mm vs. 30.8 ± 3.7 mm, p < 0.001, respectively). An increase in tubular ascending aorta size was associated with the presence of AAA by both 2D-TTE and CT (r = 0.40, p < 0.001 and r = 0.37, p < 0.001, respectively). The tubular ascending aorta (D diameter) size of ≥33 mm or ≥ 19 mm/m2 presented with 2–4 times more risk of AAA presence (OR 4.68, CI 2.18–10.25, p = 0.001 or OR 2.63, CI 1.21–5.62, p = 0.02, respectively). In addition, multiple logistic regression analysis identified tubular ascending aorta (OR 1.46, p < 0.001), age (OR 1.09, p = 0.013), gender (OR 0.12, p = 0.002), and LVESD (OR 1.24, p = 0.009) as independent risk factors of AAA presence. Conclusions An increased tubular ascending aortic diameter, measured by 2D-TTE, is associated with the presence of AAA. Routine 2D-TTE screening for silent AAA by means of ascending aorta analysis, may appear useful especially in older patients with a dilated tubular ascending aorta (≥33 mm). Supplementary Information The online version contains supplementary material available at 10.1186/s13019-021-01488-w.
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Affiliation(s)
- Enrique Gallego-Colon
- Cardiology Department, Barzilai Medical Center Campus, Barzilai University Medical Center, Ben-Gurion University, Ashkelon, Israel.
| | - Chaim Yosefy
- Cardiology Department, Barzilai Medical Center Campus, Barzilai University Medical Center, Ben-Gurion University, Ashkelon, Israel
| | - Evgenia Cherniavsky
- Department of Medical Imaging, Barzilai University Medical Center, Ben-Gurion University, Ashkelon, Israel
| | - Azriel Osherov
- Cardiology Department, Barzilai Medical Center Campus, Barzilai University Medical Center, Ben-Gurion University, Ashkelon, Israel
| | - Vladimir Khalameizer
- Cardiology Department, Barzilai Medical Center Campus, Barzilai University Medical Center, Ben-Gurion University, Ashkelon, Israel
| | - Xavier Piltz
- Department of Medical Imaging, Barzilai University Medical Center, Ben-Gurion University, Ashkelon, Israel
| | - Marina Pery
- Cardiology Department, Barzilai Medical Center Campus, Barzilai University Medical Center, Ben-Gurion University, Ashkelon, Israel
| | - Sharon Bruoha
- Cardiology Department, Barzilai Medical Center Campus, Barzilai University Medical Center, Ben-Gurion University, Ashkelon, Israel
| | - Jamal Jafari
- Cardiology Department, Barzilai Medical Center Campus, Barzilai University Medical Center, Ben-Gurion University, Ashkelon, Israel
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155
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Montanarella M, Harmon TS, Concepcion C, Pirris J, Matteo J. A Simple Target Will Save the Day and the Kidney: This Is How We Perform Our Endovascular Fenestrated Graft Procedure. Cureus 2021; 13:e14641. [PMID: 34046275 PMCID: PMC8141211 DOI: 10.7759/cureus.14641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
With the advent of state-of-the-art imaging modalities, increasing population age, and advanced preventive medical treatments, medical device design attempts to keep up with procedural demand. An abdominal aortic aneurysm (AAA) is a recognized, potentially fatal disease process where strides have been made in screening, detection, and treatment since its discovery. With the introduction of percutaneous endograft procedures in 1991, open surgical treatment is nearly a lost art. Endovascular aortic repair is now the gold standard. However, short landing zone necks, hostile angulation, and markedly dilated seal zones present challenges for one size fits all endovascular aortic devices. Suprarenal and juxtarenal fenestrated aortic grafts are the most advanced individually customized grafts invented to date. Subsequently, proper placement of these complex devices still presents challenges. We present a method for preoperative renal stent placement for target purposes. This article includes a pictorial guide and describes the tips and pitfalls for easy proper AAA exclusion with a fenestrated aortic graft. We were successful in the deployment of the fenestrated graft device and the exclusion of an aortic aneurysm while preserving the patency of the renal arteries. The patient had no postoperative complications. During 18-month postoperative surveillance, imaging demonstrated proper graft positioning without evidence of an endoleak. In fenestrated endovascular aortic repair, preoperative renal stenting is paramount for targeting purposes. This allows for the precise and timely deployment of the renal limbs through the fenestrations while minimizing the risk of postoperative complications, including renal artery occlusion.
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Affiliation(s)
| | - Taylor S Harmon
- Radiology, University of Florida College of Medicine, Jacksonville, USA
| | | | - John Pirris
- Cardiothoracic Surgery, University of Florida College of Medicine, Jacksonville, USA
| | - Jerry Matteo
- Radiology, University of Florida College of Medicine, Jacksonville, USA
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156
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Zhou M, Wang X, Shi Y, Ding Y, Li X, Xie T, Shi Z, Fu W. Deficiency of ITGAM Attenuates Experimental Abdominal Aortic Aneurysm in Mice. J Am Heart Assoc 2021; 10:e019900. [PMID: 33749307 PMCID: PMC8174368 DOI: 10.1161/jaha.120.019900] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Background Integrin αM (CD11b), which is encoded by the Integrin Subunit Alpha M (ITGAM) gene, is not only a surface marker of monocytes but also an essential adhesion molecule. In this study, we investigated the effect of CD11b on experimental abdominal aortic aneurysm and the potential underlying mechanisms. Methods and Results The incidence of abdominal aortic aneurysm was not significantly lower in ITGAM(‐/‐) mice than in control mice. Nevertheless, knockout of CD11b reduced the maximum abdominal aortic diameter, macrophage infiltration, matrix metalloproteinase‐9 expression, and elastin and collagen degradation. Additionally, lower expression of IL‐6 was found in both the peripheral blood and abdominal aortas of ITGAM(‐/‐) mice, indicating a biological correlation between CD11b and the inflammatory response in abdominal aortic aneurysm. In vitro, the number of ITGAM(‐/‐) bone marrow–derived macrophages (BMDMs) that adhered to endothelial cells was significantly lower than the number of wild‐type BMDMs. Moreover, the CD11b monoclonal antibody and CD11b agonist leukadherin‐1 decreased and increased the number of adherent wild‐type BMDMs, respectively. Through RNA sequencing, genes associated with leukocyte transendothelial migration were found to be downregulated in ITGAM(‐/‐) BMDMs. Furthermore, immunoprecipitation–mass spectrometry analysis predicted that the Akt pathway might be responsible for the impaired transmigratory ability of ITGAM(‐/‐) BMDMs. The reduced activation of Akt was then confirmed, and the Akt agonist SC79 partially rescued the transendothelial migratory function of ITGAM(‐/‐) BMDMs. Conclusions CD11b might promote the development and progression of abdominal aortic aneurysm by mediating the endothelial cells adhesion and transendothelial migration of circulating monocytes/macrophages.
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Affiliation(s)
- Min Zhou
- Department of Vascular Surgery Zhongshan Hospital Fudan University Shanghai China
| | - Xia Wang
- Department of Ultrasound in Medicine Shanghai Jiao Tong University Affiliated Sixth People's Hospital Shanghai China
| | - Yiqin Shi
- Department of Nephrology Zhongshan Hospital Fudan University Shanghai China
| | - Yong Ding
- Department of Vascular Surgery Zhongshan Hospital Fudan University Shanghai China
| | - Xu Li
- Department of Vascular Surgery Zhongshan Hospital Fudan University Shanghai China
| | - Tianchen Xie
- Department of Vascular Surgery Zhongshan Hospital Fudan University Shanghai China
| | - Zhenyu Shi
- Department of Vascular Surgery Zhongshan Hospital Fudan University Shanghai China
| | - Weiguo Fu
- Department of Vascular Surgery Zhongshan Hospital Fudan University Shanghai China
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157
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Bhave NM, Eagle KA. A tear in the fabric: unravelling gender differences in aortic dissection. Eur Heart J 2021; 41:2439-2441. [PMID: 32558885 DOI: 10.1093/eurheartj/ehaa466] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Affiliation(s)
- Nicole M Bhave
- University of Michigan, Michigan Medicine, Ann Arbor, MI, USA
| | - Kim A Eagle
- University of Michigan, Michigan Medicine, Ann Arbor, MI, USA
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158
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Gouveia E Melo R, Silva Duarte G, Lopes A, Alves M, Caldeira D, Fernandes E Fernandes R, Mendes Pedro L. Incidence and Prevalence of Thoracic Aortic Aneurysms: A Systematic Review and Meta-analysis of Population-Based Studies. Semin Thorac Cardiovasc Surg 2021; 34:1-16. [PMID: 33705940 DOI: 10.1053/j.semtcvs.2021.02.029] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 02/01/2021] [Indexed: 11/11/2022]
Abstract
Thoracic aortic aneurysms (TAA) may grow asymptomatically until they rupture, with a mortality over 90%. The true incidence and prevalence of this condition is uncertain and epidemiologic data is scarce, understudied and dispersed. Therefore, we aimed to conduct a systematic review and meta-analysis of the incidence and prevalence of TAAs in population-based studies. We searched MEDLINE, EMBASE and CENTRAL from inception to October 2020 for all population-based studies reporting on incidence and/or prevalence of TAAs. Data were pooled using a random effects model. The main outcome was the overall available worldwide incidence and prevalence of TAAs. The secondary outcomes were to evaluate the incidence of ruptured TAAs, differences in the location of these aneurysms (either ascending, arch or descending aorta) and differences in prevalence/incidence across different study designs. Twenty-two studies were included in the review and meta-analysis. The pooled incidence and prevalence of TAAs was 5.3 per 100,000 individuals/year (95% confidence interval [CI]: 3.0; 8.3) and 0.16% (95% CI: 0.12; 0.20), respectively. The pooled incidence of ruptured aneurysms was 1.6 per 100,000 individuals/year (95% CI: 1.3; 2.1). We found a significant difference of the prevalence in autopsy-only studies, which was 0.76% (95% CI: 0.47; 1.13) and the prevalence of TAAs dropped down to 0.07% (95% CI: 0.05;0.11) when these studies were excluded from the overall analysis. The current epidemiologic information provided serve as a base for future public-health decisions. The lack of well-design population-base studies and the limitations encountered serve as calling for future research in this field.
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Affiliation(s)
- Ryan Gouveia E Melo
- Vascular Surgery Department, Hospital Santa Maria, Centro Hospitalar Universitário Lisboa Norte (CHULN), Lisboa, Portugal; Faculty of Medicine, University of Lisbon, Lisboa, Portugal; Cardiovascular Center of the University of Lisbon (CCUL), Lisboa, Portugal.
| | - Gonçalo Silva Duarte
- Faculty of Medicine, University of Lisbon, Lisboa, Portugal; Laboratory of Clinical Pharmacology and Therapeutics, Faculty of Medicine, University of Lisbon, Lisboa, Portugal; Instituto de Medicina Molecular, Faculty of Medicine, University of Lisbon, Lisboa, Portugal
| | - Alice Lopes
- Vascular Surgery Department, Hospital Santa Maria, Centro Hospitalar Universitário Lisboa Norte (CHULN), Lisboa, Portugal; Cardiovascular Center of the University of Lisbon (CCUL), Lisboa, Portugal
| | - Mariana Alves
- Faculty of Medicine, University of Lisbon, Lisboa, Portugal; Laboratory of Clinical Pharmacology and Therapeutics, Faculty of Medicine, University of Lisbon, Lisboa, Portugal; Instituto de Medicina Molecular, Faculty of Medicine, University of Lisbon, Lisboa, Portugal; Serviço de Medicina III, Hospital Pulido Valente (CHULN), Lisboa, Portugal
| | - Daniel Caldeira
- Faculty of Medicine, University of Lisbon, Lisboa, Portugal; Cardiovascular Center of the University of Lisbon (CCUL), Lisboa, Portugal; Laboratory of Clinical Pharmacology and Therapeutics, Faculty of Medicine, University of Lisbon, Lisboa, Portugal; Instituto de Medicina Molecular, Faculty of Medicine, University of Lisbon, Lisboa, Portugal; Serviço de Cardiologia, Hospital Universitário de Santa Maria (CHULN), Lisboa, Portugal
| | - Ruy Fernandes E Fernandes
- Vascular Surgery Department, Hospital Santa Maria, Centro Hospitalar Universitário Lisboa Norte (CHULN), Lisboa, Portugal; Faculty of Medicine, University of Lisbon, Lisboa, Portugal; Cardiovascular Center of the University of Lisbon (CCUL), Lisboa, Portugal
| | - Luís Mendes Pedro
- Vascular Surgery Department, Hospital Santa Maria, Centro Hospitalar Universitário Lisboa Norte (CHULN), Lisboa, Portugal; Faculty of Medicine, University of Lisbon, Lisboa, Portugal; Cardiovascular Center of the University of Lisbon (CCUL), Lisboa, Portugal
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159
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Bains P, Oliffe JL, Mackay MH, Kelly MT. Screening Older Adult Men for Abdominal Aortic Aneurysm: A Scoping Review. Am J Mens Health 2021; 15:15579883211001204. [PMID: 33724072 PMCID: PMC7970195 DOI: 10.1177/15579883211001204] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 01/28/2021] [Accepted: 02/10/2021] [Indexed: 11/25/2022] Open
Abstract
Abdominal aortic aneurysm (AAA) is a potentially fatal condition predominantly affecting older adult men (60 years or over). Based on evidence, preventative health-care guidelines recommend screening older males for AAA using ultrasound. In attempts to reduce AAA mortality among men, screening has been utilized for early detection in some Western countries including the UK and Sweden. The current scoping review includes 19 empirical studies focusing on AAA screening in men. The findings from these studies highlight benefits and potential harms of male AAA screening. The benefits of AAA screening for men include decreased incidence of AAA rupture, decreased AAA mortality, increased effectiveness of elective AAA repair surgery, and cost-effectiveness. The potential harms of AAA screening included lack of AAA mortality reduction, negative impacts on quality of life, and inconsistent screening eligibility criteria being applied by primary care practitioners. The current scoping review findings are discussed to suggest changes to AAA screening guidelines and improve policy and practice.
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Affiliation(s)
- Priya Bains
- School of Nursing, University of
British Columbia, Vancouver, BC, Canada
| | - John L. Oliffe
- School of Nursing, University of
British Columbia, Vancouver, BC, Canada
- Department of Nursing, University
of Melbourne, Melbourne, VIC, Australia
| | - Martha H. Mackay
- School of Nursing, University of
British Columbia, Vancouver, BC, Canada
- Centre for Health Evaluation and
Outcomes Sciences, Vancouver, BC, Canada
| | - Mary T. Kelly
- School of Nursing, University of
British Columbia, Vancouver, BC, Canada
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160
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Durieux R, Sakalihasan N, Defraigne JO. [Opportunistic screening for abdominal aortic aneurysm during echocardiography in patients with coronary artery disease: Utility or futility?]. Ann Cardiol Angeiol (Paris) 2021; 71:53-58. [PMID: 33640149 DOI: 10.1016/j.ancard.2020.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Accepted: 12/29/2020] [Indexed: 10/22/2022]
Abstract
Abdominal aortic aneurysm is a chronic degenerative disease that is usually silent until rupture occurs and this complication is still associated in contemporary era with a high rate of mortality. Screening programmes for abdominal aortic aneurysm have been shown to be effective in reducing global mortality in the screened population but these programmes are poorly implemented in the Western countries. As coronary artery disease and abdominal aorta aneurysmal disease share many risk factors, the cardiologist is centrally positioned in the screening strategy, not only to identify patients with higher risk of developing abdominal aortic aneurysm, but also to perform an opportunistic screening during echocardiography. This paper summarises evidence about the feasibility, indications, modalities, benefits and risks related to the opportunistic screening for abdominal aortic aneurysm during echocardiography with a particular emphasis on the population of patients with coronary artery disease.
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Affiliation(s)
- R Durieux
- Service de chirurgie cardio-vasculaire, CHU de Liège, domaine universitaire du Sart-Tilman, B35, 4000 Liège, Belgique.
| | - N Sakalihasan
- Service de chirurgie cardio-vasculaire, CHU de Liège, domaine universitaire du Sart-Tilman, B35, 4000 Liège, Belgique
| | - J O Defraigne
- Service de chirurgie cardio-vasculaire, CHU de Liège, domaine universitaire du Sart-Tilman, B35, 4000 Liège, Belgique
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161
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Moran CS, Biros E, Krishna SM, Morton SK, Sexton DJ, Golledge J. Kallikrein-1 Blockade Inhibits Aortic Expansion in a Mouse Model and Reduces Prostaglandin E2 Secretion From Human Aortic Aneurysm Explants. J Am Heart Assoc 2021; 10:e019372. [PMID: 33599139 PMCID: PMC8174241 DOI: 10.1161/jaha.120.019372] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Background Abdominal aortic aneurysm (AAA) is an important cause of mortality in older adults. The kinin B2 receptor agonist, bradykinin, has been implicated in AAA pathogenesis through promoting inflammation. Bradykinin is generated from high- and low-molecular-weight kininogen by the serine protease kallikrein-1. The aims of this study were first to examine the effect of neutralizing kallikrein-1 on AAA development in a mouse model and second to test how blocking kallikrein-1 affected cyclooxygenase-2 and prostaglandin E2 in human AAA explants. Methods and Results Neutralization of kallikrein-1 in apolipoprotein E-deficient (ApoE-/-) mice via administration of a blocking antibody inhibited suprarenal aorta expansion in response to angiotensin (Ang) II infusion. Kallikrein-1 neutralization decreased suprarenal aorta concentrations of bradykinin and prostaglandin E2 and reduced cyclooxygenase-2 activity. Kallikrein-1 neutralization also decreased protein kinase B and extracellular signal-regulated kinase 1/2 phosphorylation and reduced levels of active matrix metalloproteinase 2 and matrix metalloproteinase 9. Kallikrein-1 blocking antibody reduced levels of cyclooxygenase-2 and secretion of prostaglandin E2 and active matrix metalloproteinase 2 and matrix metalloproteinase 9 from human AAA explants and vascular smooth muscle cells exposed to activated neutrophils. Conclusions These findings suggest that kallikrein-1 neutralization could be a treatment target for AAA.
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Affiliation(s)
- Corey S Moran
- Queensland Research Centre for Peripheral Vascular Disease College of Medicine and Dentistry James Cook University Townsville Australia
| | - Erik Biros
- Queensland Research Centre for Peripheral Vascular Disease College of Medicine and Dentistry James Cook University Townsville Australia
| | - Smriti M Krishna
- Queensland Research Centre for Peripheral Vascular Disease College of Medicine and Dentistry James Cook University Townsville Australia
| | - Susan K Morton
- Queensland Research Centre for Peripheral Vascular Disease College of Medicine and Dentistry James Cook University Townsville Australia
| | | | - Jonathan Golledge
- Queensland Research Centre for Peripheral Vascular Disease College of Medicine and Dentistry James Cook University Townsville Australia.,Department of Vascular and Endovascular Surgery Townsville University Hospital Townsville Australia
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162
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Shi F, Ma C, Ji C, Li M, Liu X, Han Y. Serum Lipid Oxidative Stress Products as Risk Factors Are the Candidate Predictive Biomarkers for Human Abdominal Aortic Aneurysms. Clin Appl Thromb Hemost 2021; 26:1076029620932226. [PMID: 32571088 PMCID: PMC7427010 DOI: 10.1177/1076029620932226] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
This research was designed to determine the association of serum lipid peroxidation products with disease severity in patients with abdominal aortic aneurysm (AAA). In total, 76 pairs of AAA cases as well as matched controls were enrolled in our research using propensity score matching (PSM). And their malondialdehyde (MDA), lipid hydroperoxide (LPO), and glutathione peroxidase (GSH-Px) levels were also detected through enzyme-linked immunosorbent assay (ELISA). Additionally, the relative clinical data of enrolled participants were extracted. The serum biomarker concentrations were measured in 76 patients with AAAs (diameter between 30 and 54 mm, n = 54; diameter ≥55 mm, n = 22) and 76 control patients from observational cohort study. After PSM adjustment for clinical variables, including age, gender, heart ratio, body mass index, smoking, hypertension, diabetes mellitus, coronary heart disease, and stroke, the serum MDA and LPO among AAA cases were remarkably increased compared with those from the normal patients. Inversely, serum GSH-Px was significantly decreased in patients with AAA compared to the control group. Besides, the serum levels of MDA and LPO were independently associated with AAA risk. Typically, there was significantly positive correlation between MDA level and LPO level (R = 0.358) but negative correlation of MDA level with GSH-Px (R = -0.203) level in patients with AAA. Meanwhile, the area under the receiver operating characteristic curve was 0.965 when MDA was used to diagnose AAA, and the optimal threshold value was 0.242 nmol/mL. Moreover, serum MDA level was significantly increased in cases with rupture AAA compared to those in selective AAA cases. Logistic regression analysis suggested that a higher serum MDA level indicated an elevated risk of AAA rupture (odds ratio = 2.536; 95% CI: 1.037-6.203; P =0.041). Our present findings suggest that serum peroxidation contents were evidently changed among AAA cases. Serum MDA and LPO concentrations could be used to predict disease severity in patients with AAA. Moreover, serum MDA may serve as the candidate biomarker for diagnosis of AAA and accurate identification of increased risks of AAA rupture.
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Affiliation(s)
- Feng Shi
- Department of Health Management, Shengjing Hospital of China Medical University, Shenyang, China
| | - Changcheng Ma
- Department of Clinical Laboratory, Shengjing Hospital of China Medical University, Shenyang, China
| | - Chao Ji
- Department of Clinical Epidemiology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Mu Li
- Department of General Surgery, Shengjing Hospital of China Medical University, Shenyang, China
| | - Xun Liu
- Department of General Surgery, Shengjing Hospital of China Medical University, Shenyang, China
| | - Yanshuo Han
- School of Life and Pharmaceutical Sciences, Dalian University of Technology, Panjin, China
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163
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Krist AH, Davidson KW, Mangione CM, Barry MJ, Cabana M, Caughey AB, Donahue K, Doubeni CA, Epling JW, Kubik M, Ogedegbe G, Pbert L, Silverstein M, Simon MA, Tseng CW, Wong JB. Screening for Asymptomatic Carotid Artery Stenosis: US Preventive Services Task Force Recommendation Statement. JAMA 2021; 325:476-481. [PMID: 33528542 DOI: 10.1001/jama.2020.26988] [Citation(s) in RCA: 51] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
IMPORTANCE Carotid artery stenosis is atherosclerotic disease that affects extracranial carotid arteries. Asymptomatic carotid artery stenosis refers to stenosis in persons without a history of ischemic stroke, transient ischemic attack, or other neurologic symptoms referable to the carotid arteries. The prevalence of asymptomatic carotid artery stenosis is low in the general population but increases with age. OBJECTIVE To determine if its 2014 recommendation should be reaffirmed, the US Preventive Services Task Force (USPSTF) commissioned a reaffirmation evidence review. The reaffirmation update focused on the targeted key questions on the potential benefits and harms of screening and interventions, including revascularization procedures designed to improve carotid artery blood flow, in persons with asymptomatic carotid artery stenosis. POPULATION This recommendation statement applies to adults without a history of transient ischemic attack, stroke, or other neurologic signs or symptoms referable to the carotid arteries. EVIDENCE ASSESSMENT The USPSTF found no new substantial evidence that could change its recommendation and therefore concludes with moderate certainty that the harms of screening for asymptomatic carotid artery stenosis outweigh the benefits. RECOMMENDATION The USPSTF recommends against screening for asymptomatic carotid artery stenosis in the general adult population. (D recommendation).
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Affiliation(s)
| | - Alex H Krist
- Fairfax Family Practice Residency, Fairfax, Virginia
- Virginia Commonwealth University, Richmond
| | - Karina W Davidson
- Feinstein Institute for Medical Research at Northwell Health, Manhasset, New York
| | | | | | | | | | | | | | | | | | | | - Lori Pbert
- University of Massachusetts Medical School, Worcester
| | | | | | - Chien-Wen Tseng
- University of Hawaii, Honolulu
- Pacific Health Research and Education Institute, Honolulu, Hawaii
| | - John B Wong
- Tufts University School of Medicine, Boston, Massachusetts
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164
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Gavish L, Gilon D, Beeri R, Zuckerman A, Nachman D, Gertz SD. Photobiomodulation and estrogen stabilize mitochondrial membrane potential in angiotensin-II challenged porcine aortic smooth muscle cells. JOURNAL OF BIOPHOTONICS 2021; 14:e202000329. [PMID: 32888351 DOI: 10.1002/jbio.202000329] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Revised: 09/01/2020] [Accepted: 09/02/2020] [Indexed: 06/11/2023]
Abstract
Rupture of Abdominal aortic aneurysm (AAA) is among the 15 leading causes of death after age 65. Using high frequency ultrasound, we showed that photobiomodulation (PBM) prevents formation and progression of AAA in the angiotensin-II (Ang-II)-infused, apolipoprotein-e-deficient mouse model. In the current study we report that while challenge of porcine aortic Smooth Muscle Cells (SMCs) with Ang-II (1 μM) resulted in a marked decay in mitochondrial membrane potential (MitMP) vs non-challenged cells, treatment with PBM (continuous diode laser, 780 nm, 6.7 mW/cm2 , 5 minutes, 2 J/cm2 ) or pre-incubation with estrogen (50 nM, 1 hour) significantly attenuated this deterioration in MitMP. We also report that PBM and estrogen markedly affected porcine aortic SMC contraction and modified mitochondrial dispersion reflecting important influence on SMC function. These studies provide strong evidence of the important underlying role of mitochondria in the preventive effect of PBM on formation and progression of AAA and its reduced incidence and delayed onset in women.
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Affiliation(s)
- Lilach Gavish
- Institute for Research in Military Medicine (IRMM) of The Faculty of Medicine, The Hebrew University of Jerusalem and the Israel Defense Forces Medical Corps, Jerusalem, Israel
- The Saul and Joyce Brandman Cardiovascular Research Hub of the Institute for Medical Research (IMRIC), Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Dan Gilon
- Institute for Research in Military Medicine (IRMM) of The Faculty of Medicine, The Hebrew University of Jerusalem and the Israel Defense Forces Medical Corps, Jerusalem, Israel
- The Saul and Joyce Brandman Cardiovascular Research Hub of the Institute for Medical Research (IMRIC), Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel
- Department of Cardiology, Heart Institute, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Ronen Beeri
- The Saul and Joyce Brandman Cardiovascular Research Hub of the Institute for Medical Research (IMRIC), Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel
- Department of Cardiology, Heart Institute, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Ayelet Zuckerman
- The Saul and Joyce Brandman Cardiovascular Research Hub of the Institute for Medical Research (IMRIC), Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Dean Nachman
- Institute for Research in Military Medicine (IRMM) of The Faculty of Medicine, The Hebrew University of Jerusalem and the Israel Defense Forces Medical Corps, Jerusalem, Israel
- The Saul and Joyce Brandman Cardiovascular Research Hub of the Institute for Medical Research (IMRIC), Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel
- Department of Internal Medicine, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - S David Gertz
- Institute for Research in Military Medicine (IRMM) of The Faculty of Medicine, The Hebrew University of Jerusalem and the Israel Defense Forces Medical Corps, Jerusalem, Israel
- The Saul and Joyce Brandman Cardiovascular Research Hub of the Institute for Medical Research (IMRIC), Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel
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165
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Affiliation(s)
- Priscilla Y Hsue
- University of California San Francisco, Zuckerberg San Francisco General Hospital, San Francisco, CA, USA
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166
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Meital LT, Schulze K, Magee R, O’Donnell J, Jha P, Meital CY, Donkin R, Bailey TG, Askew CD, Russell FD. Long Chain Omega-3 Polyunsaturated Fatty Acids Improve Vascular Stiffness in Abdominal Aortic Aneurysm: A Randomized Controlled Trial. Nutrients 2020; 13:E138. [PMID: 33396567 PMCID: PMC7824679 DOI: 10.3390/nu13010138] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Revised: 12/29/2020] [Accepted: 12/29/2020] [Indexed: 11/16/2022] Open
Abstract
Abdominal aortic aneurysm (AAA) is a vascular disease involving permanent focal dilation of the abdominal aorta (≥30 mm) that can lead to catastrophic rupture. Destructive remodeling of aortic connective tissue in AAA contributes to wall stiffening, a mechanical parameter of the arterial system linked to a heightened risk of cardiovascular morbidity and mortality. Since aortic stiffening is associated with AAA progression, treatment options that target vascular inflammation would appear prudent. Given this, and growing evidence indicating robust anti-inflammatory and vasoprotective properties for long chain omega-3 polyunsaturated fatty acids (LC n-3 PUFAs), this study evaluated the impact of these nutrients (1.8 g/day for 12 weeks) on indices of vascular stiffness in patients with AAA. At baseline, pulse wave velocity (PWV) and augmentation index normalized to a heart rate of 75 bpm (AIx75) were significantly higher in patients with AAA compared to control participants (PWV: 14.2 ± 0.4 m.s-1 vs. 12.6 ± 0.4 m.s-1, p = 0.014; AIx75: 26.4 ± 1.7% vs. 17.3 ± 2.7%, p = 0.005). Twelve-week LC n-3 PUFA supplementation significantly decreased PWV (baseline: 14.2 ± 0.6 m.s-1, week 12: 12.8 ± 0.7 m.s-1, p = 0.014) and heart rate (baseline: 63 ± 3 bpm, week 12: 58 ± 3 bpm, p = 0.009) in patients with AAA. No change was observed for patients receiving placebo capsules. While this raises the possibility that LC n-3 PUFAs provide improvements in aortic stiffness in patients with AAA, the clinical implications remain to be fully elucidated.
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Affiliation(s)
- Lara T. Meital
- Centre for Genetics, Ecology & Physiology, University of the Sunshine Coast, Maroochydore, QLD 4556, Australia;
- School of Health and Behavioural Sciences, University of the Sunshine Coast, Maroochydore, QLD 4556, Australia; (R.D.); (C.D.A.)
| | - Karl Schulze
- Sunshine Vascular, Buderim, QLD 4556, Australia;
| | - Rebecca Magee
- Department of Surgery, Sunshine Coast University Hospital, Birtinya, QLD 4575, Australia; (R.M.); (J.O.); (P.J.)
| | - Jill O’Donnell
- Department of Surgery, Sunshine Coast University Hospital, Birtinya, QLD 4575, Australia; (R.M.); (J.O.); (P.J.)
| | - Pankaj Jha
- Department of Surgery, Sunshine Coast University Hospital, Birtinya, QLD 4575, Australia; (R.M.); (J.O.); (P.J.)
| | - Chaim Y. Meital
- Moffat Beach Family Medical Practice, Moffat Beach, QLD 4551, Australia;
| | - Rebecca Donkin
- School of Health and Behavioural Sciences, University of the Sunshine Coast, Maroochydore, QLD 4556, Australia; (R.D.); (C.D.A.)
| | - Tom G. Bailey
- Physiology and Ultrasound Laboratory in Science and Exercise (PULSE), Centre for Research on Exercise, Physical Activity and Health, School of Human Movement and Nutrition Sciences, The University of Queensland, Queensland, QLD 4343, Australia;
- School of Nursing, Midwifery and Social Work, The University of Queensland, Queensland, QLD 4343, Australia
| | - Christopher D. Askew
- School of Health and Behavioural Sciences, University of the Sunshine Coast, Maroochydore, QLD 4556, Australia; (R.D.); (C.D.A.)
- VasoActive Research Group, Sunshine Coast Health Institute, Sunshine Coast Hospital and Health Service, Birtinya, QLD 4575, Australia
| | - Fraser D. Russell
- Centre for Genetics, Ecology & Physiology, University of the Sunshine Coast, Maroochydore, QLD 4556, Australia;
- School of Health and Behavioural Sciences, University of the Sunshine Coast, Maroochydore, QLD 4556, Australia; (R.D.); (C.D.A.)
- VasoActive Research Group, Sunshine Coast Health Institute, Sunshine Coast Hospital and Health Service, Birtinya, QLD 4575, Australia
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167
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Malayala SV, Raza A, Vanaparthy R. Gender-Based Differences in Abdominal Aortic Aneurysm Rupture: A Retrospective Study. J Clin Med Res 2020; 12:794-802. [PMID: 33447313 PMCID: PMC7781278 DOI: 10.14740/jocmr4376] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2020] [Accepted: 10/31/2020] [Indexed: 12/04/2022] Open
Abstract
Background Annually, 5% of sudden deaths are due to abdominal aortic aneurysm (AAA) rupture. There is evidence suggesting that AAA ruptures have worse outcomes in females than males and the aneurysms rupture at a smaller size in females than in males. The United States Preventive Services Task Force (USPSTF) recommends a one-time ultrasound screening for males aged 65 - 75 years who ever smoked. There is insufficient evidence to screen females aged 65 - 75 years who ever smoked though there is evidence suggesting that AAAs rupture at a smaller size and have worse outcomes in females. The objective of this study is to compare the characteristics, mortality and morbidity of ruptured AAAs in females and males. Methods This is a retrospective review of 117 patients from two teaching institutions over a period of 6 years. A total of 39 parameters were compared between males and females including demographic variables, comorbidities like hypertension, dyslipidemia, cardiovascular diseases; previous history of AAA; medications, characteristics of aneurysm, type of surgery and its outcome; postoperative complications and long-term survival. Results The overall incidence of AAA rupture was higher in males (68%) than in females (32%). Females die from AAA rupture at a later age. There was a significant difference in the size of AAA rupture between females (mean = 7.4 cm, standard deviation (SD) = 2.0) and males (mean = 8.2 cm, SD = 1.8; P = 0.04). The probability to undergo surgery for ruptured AAA was significantly lower for females as compared to males (P = 0.03). Females had higher overall mortality (P = 0.001), postoperative mortality (P = 0.02), higher length of intensive care unit (ICU) stay, incidence of postoperative complications, use of vasopressors and use of ventilator. Conclusions Using a similar threshold of size of AAA for elective surgery for both males and females might not be appropriate. Further population-based studies are needed to warrant AAA screening for high-risk females owing to the higher morbidity and mortality.
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Affiliation(s)
| | - Ambreen Raza
- Department of Medicine, Bristol Hospital, Farmington, CT, USA
| | - Rachana Vanaparthy
- Department of Pulmonology, Oregon Health and Science University, Portland, OR, USA
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168
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Bruder L, Pelisek J, Eckstein HH, Gee MW. Biomechanical rupture risk assessment of abdominal aortic aneurysms using clinical data: A patient-specific, probabilistic framework and comparative case-control study. PLoS One 2020; 15:e0242097. [PMID: 33211767 PMCID: PMC7676745 DOI: 10.1371/journal.pone.0242097] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Accepted: 10/26/2020] [Indexed: 11/18/2022] Open
Abstract
We present a data-informed, highly personalized, probabilistic approach for the quantification of abdominal aortic aneurysm (AAA) rupture risk. Our novel framework builds upon a comprehensive database of tensile test results that were carried out on 305 AAA tissue samples from 139 patients, as well as corresponding non-invasively and clinically accessible patient-specific data. Based on this, a multivariate regression model is created to obtain a probabilistic description of personalized vessel wall properties associated with a prospective AAA patient. We formulate a probabilistic rupture risk index that consistently incorporates the available statistical information and generalizes existing approaches. For the efficient evaluation of this index, a flexible Kriging-based surrogate model with an active training process is proposed. In a case-control study, the methodology is applied on a total of 36 retrospective, diameter matched asymptomatic (group 1, n = 18) and known symptomatic/ruptured (group 2, n = 18) cohort of AAA patients. Finally, we show its efficacy to discriminate between the two groups and demonstrate competitive performance in comparison to existing deterministic and probabilistic biomechanical indices.
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Affiliation(s)
- Lukas Bruder
- Mechanics & High Performance Computing Group, Technical University of Munich, Garching, Germany
| | - Jaroslav Pelisek
- Department of Vascular Surgery, University Hospital Zurich, Zurich, Switzerland
- Clinic for Vascular and Endovascular Surgery, Technical University of Munich, Munich, Germany
| | - Hans-Henning Eckstein
- Clinic for Vascular and Endovascular Surgery, Technical University of Munich, Munich, Germany
| | - Michael W. Gee
- Mechanics & High Performance Computing Group, Technical University of Munich, Garching, Germany
- * E-mail:
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169
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Commentary: Lack of screening makes primary prevention most effective to reduce the mortality of aortic dissection. J Thorac Cardiovasc Surg 2020; 161:1202-1203. [PMID: 33069427 DOI: 10.1016/j.jtcvs.2020.09.031] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 09/09/2020] [Accepted: 09/09/2020] [Indexed: 11/21/2022]
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170
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de Boer AR, Vaartjes I, van Dis I, van Herwaarden JA, Nathoe HM, Ruigrok YM, Bots ML, Visseren FLJ. Screening for abdominal aortic aneurysm in patients with clinically manifest vascular disease. Eur J Prev Cardiol 2020; 29:1170-1176. [PMID: 33624031 DOI: 10.1093/eurjpc/zwaa014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 07/13/2020] [Accepted: 07/28/2020] [Indexed: 11/12/2022]
Abstract
AIMS Declining prevalence of abdominal aortic aneurysm (AAA) might force a more targeted screening approach (high-risk populations only) in order to maintain (cost-)effectiveness. We aimed to determine temporal changes in the prevalence of screening-detected AAA, to assess AAA-related surgery, and evaluate all-cause mortality in patients with manifest vascular disease. METHODS AND RESULTS We included patients with manifest vascular disease but without a history of AAA enrolled in the ongoing single-centre prospective UCC-SMART cohort study. Patients were screened at baseline for AAA by abdominal ultrasonography. We calculated sex- and age-specific prevalence of AAA, probability of survival in relation to the presence of AAA, and the proportion of patients undergoing AAA-related surgery. Prevalence of screening-detected AAA in 5440 screened men was 2.5% [95% confidence interval (CI) 2.1-2.9%] and in 1983 screened women 0.7% (95% CI 0.4-1.1%). Prevalence declined from 1997 until 2017 in men aged 70-79 years from 8.1% to 3.2% and in men aged 60-69 years from 5.7% to 1.0%. 36% of patients with screening-detected AAA received elective AAA-related surgery during follow-up (median time until surgery = 5.3 years, interquartile range 2.5-9.1). Patients with screening-detected AAA had a lower probability of survival (sex and age adjusted) compared to patients without screening-detected AAA (51%, 95% CI 41-64% vs. 69%, 95% CI 68-71%) after 15 years of follow-up. CONCLUSION The prevalence of screening-detected AAA has declined over the period 1997-2017 in men with vascular disease but exceeds prevalence in already established screening programs targeting 65-year-old men. Screening for AAA in patients with vascular disease may be cost-effective, but this remains to be determined.
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Affiliation(s)
- Annemarijn R de Boer
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands.,Dutch Heart Foundation, The Hague, the Netherlands
| | - Ilonca Vaartjes
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands.,Dutch Heart Foundation, The Hague, the Netherlands
| | | | - Joost A van Herwaarden
- Department of Vascular Surgery, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Hendrik M Nathoe
- Department of Cardiology, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Ynte M Ruigrok
- Department of Neurology, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Michiel L Bots
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Frank L J Visseren
- Department of Vascular Medicine, University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, 3584 CX, Utrecht, the Netherlands
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171
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Klarin D, Verma SS, Judy R, Dikilitas O, Wolford BN, Paranjpe I, Levin MG, Pan C, Tcheandjieu C, Spin JM, Lynch J, Assimes TL, Åldstedt Nyrønning L, Mattsson E, Edwards TL, Denny J, Larson E, Lee MTM, Carrell D, Zhang Y, Jarvik GP, Gharavi AG, Harley J, Mentch F, Pacheco JA, Hakonarson H, Skogholt AH, Thomas L, Gabrielsen ME, Hveem K, Nielsen JB, Zhou W, Fritsche L, Huang J, Natarajan P, Sun YV, DuVall SL, Rader DJ, Cho K, Chang KM, Wilson PWF, O'Donnell CJ, Kathiresan S, Scali ST, Berceli SA, Willer C, Jones GT, Bown MJ, Nadkarni G, Kullo IJ, Ritchie M, Damrauer SM, Tsao PS. Genetic Architecture of Abdominal Aortic Aneurysm in the Million Veteran Program. Circulation 2020; 142:1633-1646. [PMID: 32981348 PMCID: PMC7580856 DOI: 10.1161/circulationaha.120.047544] [Citation(s) in RCA: 66] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Supplemental Digital Content is available in the text. Abdominal aortic aneurysm (AAA) is an important cause of cardiovascular mortality; however, its genetic determinants remain incompletely defined. In total, 10 previously identified risk loci explain a small fraction of AAA heritability.
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Affiliation(s)
- Derek Klarin
- Malcolm Randall VA Medical Center, Gainesville, FL (D.K., S.T.S., S.A.B.).,Division of Vascular Surgery and Endovascular Therapy, University of Florida College of Medicine, Gainesville (D.K., S.T.S., S.A.B.).,Center for Genomic Medicine (D.K., W.Z., P.N.), Massachusetts General Hospital, Harvard Medical School, Boston.,Program in Medical and Population Genetics (D.K.), Broad Institute of MIT and Harvard, Cambridge, MA
| | - Shefali Setia Verma
- Department of Genetics (S.S.V., M.R.), Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Renae Judy
- Department of Surgery (R.J., S.M.D.), Perelman School of Medicine, University of Pennsylvania, Philadelphia.,Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA (R.J., M.G.L., K.-M.C., S.M.D.)
| | - Ozan Dikilitas
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN (O.D., I.J.K.)
| | - Brooke N Wolford
- Department of Computational Medicine and Bioinformatics (B.N.W., C.W.), University of Michigan Medical School, Ann Arbor
| | - Ishan Paranjpe
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY (I.P., G.N.)
| | - Michael G Levin
- Division of Cardiovascular Medicine (M.G.L.), Perelman School of Medicine, University of Pennsylvania, Philadelphia.,Department of Medicine (M.G.L., D.J.R., K.-M.C.), Perelman School of Medicine, University of Pennsylvania, Philadelphia.,Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA (R.J., M.G.L., K.-M.C., S.M.D.)
| | - Cuiping Pan
- Palo Alto Epidemiology Research and Information Center for Genomics (C.P.), CA
| | - Catherine Tcheandjieu
- VA Palo Alto Health Care System (C.T., J.M.S., T.L.A., P.S.T.), CA.,Division of Cardiovascular Medicine, Department of Medicine (C.T., J.M.S., T.L.A., P.S.T.), Stanford University School of Medicine, CA.,Department of Pediatric Cardiology (C.T.), Stanford University School of Medicine, CA
| | - Joshua M Spin
- VA Palo Alto Health Care System (C.T., J.M.S., T.L.A., P.S.T.), CA.,Division of Cardiovascular Medicine, Department of Medicine (C.T., J.M.S., T.L.A., P.S.T.), Stanford University School of Medicine, CA
| | - Julie Lynch
- Edith Nourse VA Medical Center, Bedford, MA (J.L.).,VA Informatics and Computing Infrastructure, VA Salt Lake City Health Care System, UT (J.L., S.L.D.)
| | - Themistocles L Assimes
- VA Palo Alto Health Care System (C.T., J.M.S., T.L.A., P.S.T.), CA.,Division of Cardiovascular Medicine, Department of Medicine (C.T., J.M.S., T.L.A., P.S.T.), Stanford University School of Medicine, CA
| | - Linn Åldstedt Nyrønning
- Department of Vascular Surgery, St. Olavs Hospital, Trondheim, Norway (L.Å.N., E.M.).,Department of Circulation and Medical Imaging (L.Å.N., E.M.), Norwegian University of Science and Technology, Trondheim, Norway
| | - Erney Mattsson
- Department of Vascular Surgery, St. Olavs Hospital, Trondheim, Norway (L.Å.N., E.M.).,Department of Circulation and Medical Imaging (L.Å.N., E.M.), Norwegian University of Science and Technology, Trondheim, Norway
| | - Todd L Edwards
- Division of Epidemiology, Department of Medicine, Vanderbilt-Ingram Cancer Center (T.L.E.), Vanderbilt University Medical Center, Nashville, TN.,Vanderbilt Genetics Institute (T.L.E., J.D.), Vanderbilt University Medical Center, Nashville, TN
| | - Josh Denny
- Vanderbilt Genetics Institute (T.L.E., J.D.), Vanderbilt University Medical Center, Nashville, TN.,Department of Biomedical Informatics (J.D., E.L., D.C.), Vanderbilt University Medical Center, Nashville, TN.,Kaiser Permanente Washington Health Research Institute, Seattle (J.D., E.L., D.C.)
| | - Eric Larson
- Department of Biomedical Informatics (J.D., E.L., D.C.), Vanderbilt University Medical Center, Nashville, TN.,Kaiser Permanente Washington Health Research Institute, Seattle (J.D., E.L., D.C.).,Departments of Medicine and Health Services (E.L.), University of Washington, Seattle
| | - Ming Ta Michael Lee
- Genomic Medicine Institute, Geisinger Health System, Danville, PA (M.T.M.L., Y.Z.)
| | - David Carrell
- Department of Biomedical Informatics (J.D., E.L., D.C.), Vanderbilt University Medical Center, Nashville, TN.,Kaiser Permanente Washington Health Research Institute, Seattle (J.D., E.L., D.C.)
| | - Yanfei Zhang
- Genomic Medicine Institute, Geisinger Health System, Danville, PA (M.T.M.L., Y.Z.)
| | - Gail P Jarvik
- Division of Medical Genetics, Departments of Medicine and Genome Sciences (G.P.J.), University of Washington, Seattle
| | - Ali G Gharavi
- Division of Nephrology and Center for Precision Medicine and Genomics, Columbia University, New York, NY (A.G.G.)
| | - John Harley
- Center for Autoimmune Genomics and Etiology (CAGE), Cincinnati Children's Hospital Medical Center, OH (J.H.).,Department of Pediatrics, University of Cincinnati College of Medicine, OH (J.H.).,US Department of Veterans Affairs, Cincinnati, OH (J.H.)
| | - Frank Mentch
- Center for Applied Genomics, The Children's Hospital of Philadelphia, PA (F.M., H.H.)
| | - Jennifer A Pacheco
- Center for Genetic Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (J.A.P.)
| | - Hakon Hakonarson
- Department of Pediatrics (H.H.), Perelman School of Medicine, University of Pennsylvania, Philadelphia.,Center for Applied Genomics, The Children's Hospital of Philadelphia, PA (F.M., H.H.)
| | - Anne Heidi Skogholt
- Faculty of Medicine and Health Sciences (A.H.S., L.T., M.E.G., K.H., J.B.N.), Norwegian University of Science and Technology, Trondheim, Norway
| | - Laurent Thomas
- Faculty of Medicine and Health Sciences (A.H.S., L.T., M.E.G., K.H., J.B.N.), Norwegian University of Science and Technology, Trondheim, Norway.,Department of Clinical and Molecular Medicine (L.T.), Norwegian University of Science and Technology, Trondheim, Norway
| | - Maiken Elvestad Gabrielsen
- Faculty of Medicine and Health Sciences (A.H.S., L.T., M.E.G., K.H., J.B.N.), Norwegian University of Science and Technology, Trondheim, Norway
| | - Kristian Hveem
- Faculty of Medicine and Health Sciences (A.H.S., L.T., M.E.G., K.H., J.B.N.), Norwegian University of Science and Technology, Trondheim, Norway
| | - Jonas Bille Nielsen
- Faculty of Medicine and Health Sciences (A.H.S., L.T., M.E.G., K.H., J.B.N.), Norwegian University of Science and Technology, Trondheim, Norway.,K.G. Jebsen Center for Genetic Epidemiology, Department of Public Health and Nursing, Department of Epidemiology Research, Statens Serum Institute, Copenhagen, Denmark (J.B.N.)
| | - Wei Zhou
- Center for Genomic Medicine (D.K., W.Z., P.N.), Massachusetts General Hospital, Harvard Medical School, Boston.,Stanley Center for Psychiatric Research (W.Z.), Broad Institute of MIT and Harvard, Cambridge, MA.,Analytic and Translational Genetics Unit (W.Z.), Massachusetts General Hospital, Boston
| | - Lars Fritsche
- Department of Biostatistics (L.F.), University of Michigan Medical School, Ann Arbor
| | - Jie Huang
- Boston VA Healthcare System, MA (J.H., P.N., K.C., C.J.O.)
| | - Pradeep Natarajan
- Center for Genomic Medicine (D.K., W.Z., P.N.), Massachusetts General Hospital, Harvard Medical School, Boston.,Department of Medicine (P.N.), Massachusetts General Hospital, Harvard Medical School, Boston.,Cardiovascular Research Center (P.N.), Massachusetts General Hospital, Boston.,Boston VA Healthcare System, MA (J.H., P.N., K.C., C.J.O.)
| | - Yan V Sun
- Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, GA (Y.V.S.).,Atlanta VA Health Care System, Decatur, GA (Y.V.S., P.W.F.W.)
| | - Scott L DuVall
- VA Informatics and Computing Infrastructure, VA Salt Lake City Health Care System, UT (J.L., S.L.D.).,Division of Epidemiology, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City (S.L.D.)
| | - Daniel J Rader
- Department of Medicine (M.G.L., D.J.R., K.-M.C.), Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Kelly Cho
- Boston VA Healthcare System, MA (J.H., P.N., K.C., C.J.O.)
| | - Kyong-Mi Chang
- Department of Medicine (M.G.L., D.J.R., K.-M.C.), Perelman School of Medicine, University of Pennsylvania, Philadelphia.,Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA (R.J., M.G.L., K.-M.C., S.M.D.)
| | - Peter W F Wilson
- Atlanta VA Health Care System, Decatur, GA (Y.V.S., P.W.F.W.).,Emory Clinical Cardiovascular Research Institute, Atlanta, GA (P.W.F.W.)
| | - Christopher J O'Donnell
- Boston VA Healthcare System, MA (J.H., P.N., K.C., C.J.O.).,Cardiovascular Medicine Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (C.J.O.)
| | | | - Salvatore T Scali
- Malcolm Randall VA Medical Center, Gainesville, FL (D.K., S.T.S., S.A.B.).,Division of Vascular Surgery and Endovascular Therapy, University of Florida College of Medicine, Gainesville (D.K., S.T.S., S.A.B.)
| | - Scott A Berceli
- Malcolm Randall VA Medical Center, Gainesville, FL (D.K., S.T.S., S.A.B.).,Division of Vascular Surgery and Endovascular Therapy, University of Florida College of Medicine, Gainesville (D.K., S.T.S., S.A.B.)
| | - Cristen Willer
- Department of Computational Medicine and Bioinformatics (B.N.W., C.W.), University of Michigan Medical School, Ann Arbor.,Department of Internal Medicine, Division of Cardiology (C.W.), University of Michigan Medical School, Ann Arbor.,Department of Human Genetics (C.W.), University of Michigan Medical School, Ann Arbor
| | - Gregory T Jones
- Department of Surgical Sciences, Dunedin School of Medicine, University of Otago, New Zealand (G.T.J.)
| | - Matthew J Bown
- Department of Cardiovascular Sciences and NIHR Leicester Biomedical Research Centre, University of Leicester, United Kingdom (M.J.B.)
| | - Girish Nadkarni
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY (I.P., G.N.)
| | - Iftikhar J Kullo
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN (O.D., I.J.K.)
| | - Marylyn Ritchie
- Department of Genetics (S.S.V., M.R.), Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Scott M Damrauer
- Department of Surgery (R.J., S.M.D.), Perelman School of Medicine, University of Pennsylvania, Philadelphia.,Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA (R.J., M.G.L., K.-M.C., S.M.D.)
| | - Philip S Tsao
- VA Palo Alto Health Care System (C.T., J.M.S., T.L.A., P.S.T.), CA.,Division of Cardiovascular Medicine, Department of Medicine (C.T., J.M.S., T.L.A., P.S.T.), Stanford University School of Medicine, CA
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172
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Paraskevas KI, Zeebregts CJ, Veith FJ. Debating the Usefulness of Abdominal Aortic Aneurysm Screening Programs: A Never-Ending Story. Angiology 2020; 72:392-393. [PMID: 32929982 DOI: 10.1177/0003319720958336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Kosmas I Paraskevas
- Department of General and Vascular Surgery, Central Clinic of Athens, Athens, Greece
| | - Clark J Zeebregts
- Division of Vascular Surgery, Department of Surgery, University Medical Center Groningen, University of Groningen, The Netherlands
| | - Frank J Veith
- Division of Vascular Surgery, New York University Langone Medical Center, NY, USA.,Division of Vascular Surgery, The Cleveland Clinic, OH, USA
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173
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Golledge J, Krishna SM, Wang Y. Mouse models for abdominal aortic aneurysm. Br J Pharmacol 2020; 179:792-810. [PMID: 32914434 DOI: 10.1111/bph.15260] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 08/25/2020] [Accepted: 09/03/2020] [Indexed: 12/21/2022] Open
Abstract
Abdominal aortic aneurysm (AAA) rupture is estimated to cause 200,000 deaths each year. Currently, the only treatment for AAA is surgical repair; however, this is only indicated for large asymptomatic, symptomatic or ruptured aneurysms, is not always durable, and is associated with a risk of serious perioperative complications. As a result, patients with small asymptomatic aneurysms or who are otherwise unfit for surgery are treated conservatively, but up to 70% of small aneurysms continue to grow, increasing the risk of rupture. There is thus an urgent need to develop drug therapies effective at slowing AAA growth. This review describes the commonly used mouse models for AAA. Recent research in these models highlights key roles for pathways involved in inflammation and cell turnover in AAA pathogenesis. There is also evidence for long non-coding RNAs and thrombosis in aneurysm pathology. Further well-designed research in clinically relevant models is expected to be translated into effective AAA drugs.
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Affiliation(s)
- Jonathan Golledge
- Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia.,The Department of Vascular and Endovascular Surgery, The Townsville University Hospital, Townsville, Queensland, Australia.,The Australian Institute of Tropical Health and Medicine, James Cook University, Townsville, Queensland, Australia
| | - Smriti Murali Krishna
- Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia.,The Department of Vascular and Endovascular Surgery, The Townsville University Hospital, Townsville, Queensland, Australia.,The Australian Institute of Tropical Health and Medicine, James Cook University, Townsville, Queensland, Australia
| | - Yutang Wang
- Discipline of Life Sciences, School of Health and Life Sciences, Federation University Australia, Ballarat, Victoria, Australia
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174
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Reilly MJ, Larsen NK, Agrawal S, Thankam FG, Agrawal DK, Fitzgibbons RJ. Selected conditions associated with an increased incidence of incisional hernia: A review of molecular biology. Am J Surg 2020; 221:942-949. [PMID: 32977928 DOI: 10.1016/j.amjsurg.2020.09.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 08/16/2020] [Accepted: 09/01/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND Incisional hernias (IH) following a laparotomy, on average, occur in 10-20% of patients, however, little is known about its molecular basis. Thus, a better understanding of the molecular mechanisms could lead to the identification of key target(s) to intervene pre-and post-operatively. METHODS We examined the current literature describing the molecular mechanisms of IH and overlap these factors with smoking, abdominal aortic aneurysm, obesity, diabetes mellitus, and diverticulitis. RESULTS The expression levels of collagen I and III, matrix metalloproteinases, and tissue inhibitors of metalloproteases are abnormal in the extracellular matrix (ECM) of IH patients and ECM disorganization has an overlap with these comorbid conditions. CONCLUSION Understanding the pathophysiology of IH development and associated risk factors will allow physicians to identify patients that may be at increased risk for IH and to possibly act preemptively to decrease the incidence of IH.
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Affiliation(s)
| | | | - Swati Agrawal
- Creighton University School of Medicine, Omaha, NE, 68178, USA; Department of Surgery, Creighton University Medical Center, Omaha, NE, 68131, USA
| | - Finosh G Thankam
- Department of Translational Research, Western University of Health Sciences, Pomona, CA, 91766, USA
| | - Devendra K Agrawal
- Department of Translational Research, Western University of Health Sciences, Pomona, CA, 91766, USA
| | - Robert J Fitzgibbons
- Department of Surgery, Creighton University Medical Center, Omaha, NE, 68131, USA.
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175
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Chou EL, Pettinger M, Haring B, Mell MW, Hlatky MA, Wactawski-Wende J, Allison MA, Wild RA, Shadyab AH, Wallace RB, Snetselaar LG, Eagleton MJ, Conrad MF, Liu S. Lipoprotein(a) levels and risk of abdominal aortic aneurysm in the Women's Health Initiative. J Vasc Surg 2020; 73:1245-1252.e3. [PMID: 32882349 DOI: 10.1016/j.jvs.2020.07.106] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Accepted: 07/26/2020] [Indexed: 12/24/2022]
Abstract
OBJECTIVE Few studies have prospectively examined the associations of lipoprotein(a) [Lp(a)] levels with the risk of abdominal aortic aneurysm (AAA), especially in women. Accounting for commonly recognized risk factors, we investigated the baseline Lp(a) levels and the risk of AAA among postmenopausal women participating in the ongoing national Women's Health Initiative. METHODS Women's Health Initiative participants with baseline Lp(a) levels available who were beneficiaries of Medicare parts A and B fee-for-service at study enrollment or who had aged into Medicare at any point were included. Participants with missing covariate data or known AAA at baseline were excluded. Thoracic aneurysms were excluded owing to the different pathophysiology. The AAA cases and interventions were identified using the International Classification of Diseases, 9th and 10th revision, codes and Current Procedural Terminology codes from claims data. Hazard ratios were computed using Cox proportional hazard models according to the quintiles of Lp(a). RESULTS The mean age of the 6615 participants included in the analysis was 65.3 years. Of the 6615 participants, 66.6% were non-Hispanic white, 18.9% were black, 7% were Hispanic and 4.7% were Asian/Pacific Islander. Compared with the participants in the lowest Lp(a) quintile, those in higher quintiles were more likely to be overweight, black, and former or current smokers, to have hypertension, hyperlipidemia, and a history of cardiovascular disease, and to use menopausal hormone therapy and statins. During 65,476 person-years of follow-up, with a median of 10.4 years, 415 women had been diagnosed with an AAA and 36 had required intervention. More than one half had required intervention for a ruptured AAA. We failed to find a statistically significant association between Lp(a) levels and incident AAA. Additional sensitivity analyses stratified by race, with exclusion of statin users and alternative categorizations of Lp(a) using log-transformed levels, tertiles, and a cutoff of >50 mg/dL, were conducted, which did not reveal any significant associations. CONCLUSIONS We found no statistically significant association between Lp(a) levels and the risk of AAA in a large and well-phenotyped sample of postmenopausal women. Women with high Lp(a) levels were more likely to be overweight, black, and former or current smokers, and to have hypertension, hyperlipidemia, and a history of cardiovascular disease, or to use hormone therapy and statins compared with those with lower Lp(a) levels. These findings differ from previous prospective, case-control, and meta-analysis studies that had supported a significant relationship between higher Lp(a) levels and an increased risk of AAA. Differences in the association could have resulted from study limitations or sex differences.
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Affiliation(s)
- Elizabeth L Chou
- Division of Vascular and Endovascular Surgery, Massachusetts General Hospital, Boston, Mass.
| | - Mary Pettinger
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Wash
| | - Bernhard Haring
- Department of Internal Medicine, University of Würzburg, Würzburg, Germany
| | - Matthew W Mell
- Division of Vascular Surgery, University of California, Davis, Medical Center, Sacramento, Calif
| | - Mark A Hlatky
- Department of Health Research and Policy, Stanford University School of Medicine, Stanford, Calif
| | - Jean Wactawski-Wende
- Department of Epidemiology and Environmental Health, State University of New York at Buffalo, Buffalo, NY
| | - Matthew A Allison
- Department of Family Medicine and Public Health, University of California, San Diego, School of Medicine, La Jolla, Calif
| | - Robert A Wild
- Department of Obstetrics and Gynecology, University of Oklahoma Health Sciences Center, Oklahoma City, Okla
| | - Aladdin H Shadyab
- Department of Family Medicine and Public Health, University of California, San Diego, School of Medicine, La Jolla, Calif
| | - Robert B Wallace
- Department of Epidemiology, College of Public Health, The University of Iowa, Iowa City, Iowa
| | - Linda G Snetselaar
- Department of Epidemiology, College of Public Health, The University of Iowa, Iowa City, Iowa
| | - Matthew J Eagleton
- Division of Vascular and Endovascular Surgery, Massachusetts General Hospital, Boston, Mass
| | - Mark F Conrad
- Division of Vascular and Endovascular Surgery, Massachusetts General Hospital, Boston, Mass
| | - Simin Liu
- Department of Epidemiology and Medicine, Brown University, Providence, RI
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176
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Nikol S, Mathias K, Olinic DM, Blinc A, Espinola-Klein C. Aneurysms and dissections - What is new in the literature of 2019/2020 - a European Society of Vascular Medicine annual review. VASA 2020; 49:1-36. [PMID: 32856993 DOI: 10.1024/0301-1526/a000865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
More than 6,000 publications were found in PubMed concerning aneurysms and dissections, including those Epub ahead of print in 2019, printed in 2020. Among those publications 327 were selected and considered of particular interest.
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Affiliation(s)
- Sigrid Nikol
- Department of Angiology, ASKLEPIOS Klinik St. Georg, Hamburg, Germany.,University of Münster, Germany
| | - Klaus Mathias
- World Federation for Interventional Stroke Treatment (WIST), Hamburg, Germany
| | - Dan Mircea Olinic
- Medical Clinic No. 1, University of Medicine and Pharmacy and Interventional Cardiology Department, Emergency Hospital, Cluj-Napoca, Romania
| | - Aleš Blinc
- Department of Vascular Diseases, University Medical Centre Ljubljana, Slovenia.,Faculty of Medicine, University of Ljubljana, Slovenia
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177
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Torres-Do Rego A, Barrientos M, Ortega-Hernández A, Modrego J, Gómez-Gordo R, Álvarez-Sala LA, Cachofeiro V, Gómez-Garre D. Identification of a Plasma Microrna Signature as Biomarker of Subaneurysmal Aortic Dilation in Patients with High Cardiovascular Risk. J Clin Med 2020; 9:jcm9092783. [PMID: 32872191 PMCID: PMC7565169 DOI: 10.3390/jcm9092783] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 08/20/2020] [Accepted: 08/26/2020] [Indexed: 12/25/2022] Open
Abstract
Patients with subaneurysmal aortic dilation (SAD; 25–29 mm diameter) are likely to progress to true abdominal aortic aneurysm (AAA). Despite these patients having a higher risk of all-cause mortality than subjects with aortic size <24 mm, early diagnostic biomarkers are lacking. MicroRNAs (miRs) are well-recognized potential biomarkers due to their differential expression in different tissues and their stability in blood. We have investigated whether a plasma miRs profile could identify the presence of SAD in high cardiovascular risk patients. Using qRT-PCR arrays in plasma samples, we determined miRs differentially expressed between SAD patients and patients with normal aortic diameter. We then selected 12 miRs to be investigated as biomarkers by construction of ROC curves. A total of 82 significantly differentially expressed miRs were found by qPCR array, and 12 were validated by qRT-PCR. ROC curve analyses showed that seven selected miRs (miR-28-3p, miR-29a-3p, miR-93-3p, miR-150-5p, miR-338-3p, miR-339-3p, and miR-378a-3p) could be valuable biomarkers for distinguishing SAD patients. MiR-339-3p showed the best sensitivity and specificity, even after combination with other miRs. Decreased miR-339-3p expression was associated with increased aortic abdominal diameter. MiR-339-3p, alone or in combination with other miRs, could be used for SAD screening in high cardiovascular risk patients, helping to the early diagnosis of asymptomatic AAA.
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Affiliation(s)
- Ana Torres-Do Rego
- Internal Medicine Service, HGU Gregorio Marañón, Instituto Investigación Sanitaria Gregorio Marañón (IiSGM), 28007 Madrid, Spain; (A.T.-D.R.); (M.B.); (L.A.Á.-S.)
| | - María Barrientos
- Internal Medicine Service, HGU Gregorio Marañón, Instituto Investigación Sanitaria Gregorio Marañón (IiSGM), 28007 Madrid, Spain; (A.T.-D.R.); (M.B.); (L.A.Á.-S.)
| | - Adriana Ortega-Hernández
- Vascular Biology Research Laboratory, Hospital Clínico San Carlos-Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), 28040 Madrid, Spain; (A.O.-H.); (J.M.); (R.G.-G.)
| | - Javier Modrego
- Vascular Biology Research Laboratory, Hospital Clínico San Carlos-Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), 28040 Madrid, Spain; (A.O.-H.); (J.M.); (R.G.-G.)
- Biomedical Research Networking Center in Cardiovascular Diseases (CIBERCV), 28029 Madrid, Spain;
| | - Rubén Gómez-Gordo
- Vascular Biology Research Laboratory, Hospital Clínico San Carlos-Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), 28040 Madrid, Spain; (A.O.-H.); (J.M.); (R.G.-G.)
| | - Luis A. Álvarez-Sala
- Internal Medicine Service, HGU Gregorio Marañón, Instituto Investigación Sanitaria Gregorio Marañón (IiSGM), 28007 Madrid, Spain; (A.T.-D.R.); (M.B.); (L.A.Á.-S.)
- Department of Medicine, School of Medicine, Universidad Complutense, 28040 Madrid, Spain
| | - Victoria Cachofeiro
- Biomedical Research Networking Center in Cardiovascular Diseases (CIBERCV), 28029 Madrid, Spain;
- Department of Physiology, School of Medicine, Universidad Complutense and Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), 28040 Madrid, Spain
| | - Dulcenombre Gómez-Garre
- Vascular Biology Research Laboratory, Hospital Clínico San Carlos-Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), 28040 Madrid, Spain; (A.O.-H.); (J.M.); (R.G.-G.)
- Biomedical Research Networking Center in Cardiovascular Diseases (CIBERCV), 28029 Madrid, Spain;
- Correspondence: ; Tel.: +34-91-330-3000 (ext. 7769)
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178
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Spanos K, Nana P, Behrendt CA, Kouvelos G, Panuccio G, Heidemann F, Matsagkas M, Debus S, Giannoukas A, Kölbel T. Management of Abdominal Aortic Aneurysm Disease: Similarities and Differences Among Cardiovascular Guidelines and NICE Guidance. J Endovasc Ther 2020; 27:889-901. [PMID: 32813590 DOI: 10.1177/1526602820951265] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
The development of endovascular techniques has improved abdominal aortic aneurysm (AAA) management over the past 2 decades. Different cardiovascular societies worldwide have recommended the endovascular approach as the standard of care in their currently available guidelines. While endovascular treatment has established its role in daily clinical practice, a new debate has arisen regarding the indications, appropriateness, limitations, and role of open surgery. To inform this debate, the MEDLINE, EMBASE, and Cochrane Central Register of Controlled Trials databases were searched from 2010 to May 2020; the systematic search identified 5 articles published between 2011 and 2020 by 4 cardiovascular societies and the National Institute of Health and Care Excellence (NICE). Four debatable domains were assessed and analyzed: diagnostic methods and screening, preoperative management, indications and treatment modalities, and postoperative follow-up and endoleak management. The review addresses controversial proposals as well as widely accepted recommendations and "gray zone" issues that need to be further investigated and analyzed, such as screening in women, medical management, and follow-up imaging. While the recommendations for AAA management have significant overlap and agreement among international cardiovascular societies, the NICE guidelines diverge regarding the role of open repair in aortic disease, recommending conventional surgery in most elective cases.
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Affiliation(s)
- Konstantinos Spanos
- Department of Vascular Surgery, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece.,German Aortic Center Hamburg, Department of Vascular Medicine, University Heart & Vascular Center, Hamburg, Germany
| | - Petroula Nana
- Department of Vascular Surgery, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece
| | - Christian-Alexander Behrendt
- German Aortic Center Hamburg, Department of Vascular Medicine, University Heart & Vascular Center, Hamburg, Germany
| | - George Kouvelos
- Department of Vascular Surgery, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece
| | - Giuseppe Panuccio
- German Aortic Center Hamburg, Department of Vascular Medicine, University Heart & Vascular Center, Hamburg, Germany
| | - Franziska Heidemann
- German Aortic Center Hamburg, Department of Vascular Medicine, University Heart & Vascular Center, Hamburg, Germany
| | - Miltiadis Matsagkas
- Department of Vascular Surgery, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece
| | - Sebastian Debus
- German Aortic Center Hamburg, Department of Vascular Medicine, University Heart & Vascular Center, Hamburg, Germany
| | - Athanasios Giannoukas
- Department of Vascular Surgery, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece
| | - Tilo Kölbel
- German Aortic Center Hamburg, Department of Vascular Medicine, University Heart & Vascular Center, Hamburg, Germany
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179
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Abstract
Objective Receptor interacting proteins kinase 1 and 3 (RIPK1 and RIPK3) have been shown to play essential roles in the pathogenesis of abdominal aortic aneurysms (AAAs) by mediating necroptosis and inflammation. We previously discovered a small molecular inhibitor GSK2593074A (GSK’074) that binds to both RIPK1 and RIPK3 with high affinity and prevents AAA formation in mice. In this study, we evaluated whether GSK’074 can attenuate progression of existing AAA in the calcium phosphate model. Methods C57BL6/J mice were subjected to the calcium phosphate model of aortic aneurysm generation. Mice were treated with either GSK’074 (4.65 mg/kg/day) or dimethylsulfoxide (DMSO) controls starting 7 days after aneurysm induction. Aneurysm growth was monitored via ultrasound imaging every 7 days until harvest on day 28. Harvested aortas were examined via immunohistochemistry. The impact of GSK’074 on vascular smooth muscle cells and macrophages were evaluated via flow cytometry and transwell migration assay. Results At the onset of treatment, mice in both the control (DMSO) and GSK’074 groups showed similar degree of aneurysmal expansion. The weekly ultrasound imaging showed a steady aneurysm growth in DMSO-treated mice. The aneurysm growth was attenuated by GSK’074 treatment. At humane killing, GSK’074-treated mice had significantly reduced progression in aortic diameter from baseline as compared with the DMSO-treated mice (83.2% ± 13.1% [standard error of the mean] vs 157.2% ± 32.0% [standard error of the mean]; P < .01). In addition, the GSK’074-treated group demonstrated reduced macrophages (F4/80, CD206, MHCII), less gelatinase activity, a higher level of smooth muscle cell-specific myosin heavy chain, and better organized elastin fibers within the aortic walls compared with DMSO controls. In vitro, GSK’074 inhibited necroptosis in mouse aortic smooth muscle cells; whereas, it was able to prevent macrophage migration without affecting Il1b and Tnf expression. Conclusions GSK’074 is able to attenuate aneurysm progression in the calcium phosphate model. The ability to inhibit both vascular smooth muscle cell necroptosis and macrophage migration makes GSK’074 an attractive drug candidate for pharmaceutical treatment of aortic aneurysms. Previous clinical trials evaluating pharmaceutical treatments in blocking aneurysm progression have failed. However, most agents used in those trials focused on inhibiting only one mechanism that contributes to aneurysm pathogenesis. In this study, we found GSK’074 is able to attenuate aneurysm progression in the calcium phosphate model by inhibiting both vascular smooth muscle cell necroptosis and macrophage migration, which are both key processes in the pathogenesis of aneurysm progression. The ability of GSK’0474 to inhibit multiple key pathologic mechanisms makes it an attractive therapeutic candidate for aneurysm progression.
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180
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Takada M, Yamagishi K, Tamakoshi A, Iso H. Body Mass Index and Mortality From Aortic Aneurysm and Dissection. J Atheroscler Thromb 2020; 28:338-348. [PMID: 32727971 PMCID: PMC8147012 DOI: 10.5551/jat.57232] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
AIMS Reports on an association between body mass index and aortic disease, which remains controversial. This study investigated the association between body mass index and mortality from aortic disease. METHODS We conducted the Japan Collaborative Cohort Study, a prospective study of 103,972 Japanese men and women aged 40-79 years. Body mass index was calculated on the basis of self-reported height and weight, and the participants were followed up from 1988-89 through 2009. Sex-specific hazard ratios (95% confidence intervals) of mortality from aortic disease according to quintiles of body mass index were analyzed using the Cox proportional hazards model. RESULTS During the median 18.8 years of follow-up, we documented 139 deaths due to aortic aneurysm (including 51 thoracic and 74 abdominal aortic aneurysms) and 134 deaths due to aortic dissection. We observed positive associations of body mass index with mortality from aortic aneurysm among men: the multivariable hazard ratios (95% confidence intervals) for highest versus lowest quintiles of body mass index were 4.48 (2.10-9.58), P for trend <0.0001 for aortic aneurysm; 6.52 (1.33-32.02), P=0.005 for thoracic aortic aneurysm; 3.81 (1.39-10.49), P=0.01 for abdominal aortic aneurysm; and 2.71 (1.59-4.62), P=0.001 for total aortic disease. No association was found for aortic dissection. Among ever-smokers (men ≥ 90%) but not never-smokers (women ≥ 84%), an association between body mass index and aortic disease mortality was observed regardless of sex, which may explain the sex difference (P for sex-interaction=0.046). CONCLUSIONS We found a positive association between body mass index and mortality from aortic aneurysm among Japanese men and smokers.
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Affiliation(s)
- Midori Takada
- Department of Public Health Medicine, Faculty of Medicine, and Health Services Research and Development Center, University of Tsukuba.,Public Health, Department of Social Medicine, Osaka University Graduate School of Medicine.,Department of Cardiovascular Disease Prevention, Osaka Center for Cancer and Cardiovascular Disease Prevention
| | - Kazumasa Yamagishi
- Department of Public Health Medicine, Faculty of Medicine, and Health Services Research and Development Center, University of Tsukuba
| | - Akiko Tamakoshi
- Department of Public Health, Hokkaido University Faculty of Medicine
| | - Hiroyasu Iso
- Department of Public Health Medicine, Faculty of Medicine, and Health Services Research and Development Center, University of Tsukuba.,Public Health, Department of Social Medicine, Osaka University Graduate School of Medicine
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181
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Ulug P, Powell JT, Martinez MAM, Ballard DJ, Filardo G. Surgery for small asymptomatic abdominal aortic aneurysms. Cochrane Database Syst Rev 2020; 7:CD001835. [PMID: 32609382 PMCID: PMC7389114 DOI: 10.1002/14651858.cd001835.pub5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
BACKGROUND An abdominal aortic aneurysm (AAA) is an abnormal ballooning of the major abdominal artery. Some AAAs present as emergencies and require surgery; others remain asymptomatic. Treatment of asymptomatic AAAs depends on many factors, but the size of the aneurysm is important, as risk of rupture increases with aneurysm size. Large asymptomatic AAAs (greater than 5.5 cm in diameter) are usually repaired surgically; very small AAAs (less than 4.0 cm diameter) are monitored with ultrasonography. Debate continues over the roles of early repair versus surveillance with repair on subsequent enlargement in people with asymptomatic AAAs of 4.0 cm to 5.5 cm diameter. This is the fourth update of the review first published in 1999. OBJECTIVES To compare mortality and costs, as well as quality of life and aneurysm rupture as secondary outcomes, following early surgical repair versus routine ultrasound surveillance in people with asymptomatic AAAs between 4.0 cm and 5.5 cm in diameter. SEARCH METHODS The Cochrane Vascular Information Specialist searched the Cochrane Vascular Specialised Register, CENTRAL, MEDLINE, two other databases, and two trials registers to 10 July 2019. We handsearched conference proceedings and checked reference lists of relevant studies. SELECTION CRITERIA We included randomised controlled trials where people with asymptomatic AAAs of 4.0 cm to 5.5 cm were randomly allocated to early repair or imaging-based surveillance at least every six months. Outcomes had to include mortality or survival. DATA COLLECTION AND ANALYSIS Three review authors independently extracted data, which were cross-checked by other team members. Outcomes were mortality, costs, quality of life, and aneurysm rupture. For mortality, we estimated risk ratios (RR) (endovascular aneurysm repair only), hazard ratios (HR) (open repair only), and 95% confidence intervals (CI) based on Mantel-Haenszel Chi2 statistics at one and six years (open repair only) following randomisation. MAIN RESULTS We found no new studies for this update. Four trials with 3314 participants fulfilled the inclusion criteria. Two trials compared early open repair with surveillance and two trials compared early endovascular repair (EVAR) with surveillance. We used GRADE to access the certainty of the evidence for mortality and cost, which ranged from high to low. We downgraded the certainty in the evidence from high to moderate and low due to risk of bias concerns and imprecision (some outcomes were only reported by one study). All four trials showed an early survival benefit in the surveillance group (due to 30-day operative mortality with repair) but no evidence of differences in long-term survival. One study compared early open repair with surveillance with an adjusted HR of 0.88 (95% CI 0.75 to 1.02, mean follow-up 10 years; HR 1.21, 95% CI 0.95 to 1.54, mean follow-up 4.9 years). Pooled analysis of participant-level data from the two trials comparing early open repair with surveillance (maximum follow-up seven to eight years) showed no evidence of a difference in survival (propensity score-adjusted HR 0.99, 95% CI 0.83 to 1.18; 2226 participants; high-certainty evidence). This lack of treatment effect did not vary to three years by AAA diameter (P = 0.39), participant age (P = 0.61), or for women (HR 0.84, 95% CI 0.62 to 1.11). Two studies compared EVAR with surveillance and there was no evidence of a survival benefit for early EVAR at 12 months (RR 1.92, 95% CI 0.73 to 5.06; 846 participants; low-certainty evidence). Two trials reported costs. The mean UK health service costs per participant over the first 18 months after randomisation were higher in the open repair surgery than the surveillance group (GBP 4978 in the repair group versus GBP 3914 in the surveillance group; mean difference (MD) GBP 1064, 95% CI 796 to 1332; 1090 participants; moderate-certainty evidence). There was a similar difference after 12 years. The mean USA hospital costs for participants at six months after randomisation were higher in the EVAR group than in the surveillance group (USD 33,471 with repair versus USD 5520 with surveillance; MD USD 27,951, 95% CI 25,156 to 30,746; 614 participants; low-certainty evidence). After four years, there was no evidence of a difference in total medical costs between groups (USD 48,669 with repair versus USD 46,112 with surveillance; MD USD 2557, 95% CI -8043 to 13,156; 614 participants; low-certainty evidence). All studies reported quality of life but used different assessment measurements and results were conflicting. All four studies reported aneurysm rupture. There were very few ruptures reported in the trials of EVAR versus surveillance up to three years. In the trials of open surgery versus surveillance, there were ruptures to at least six years and there were more ruptures in the surveillance group, but most of these ruptures occurred in aneurysms that had exceeded the threshold for surgical repair. AUTHORS' CONCLUSIONS There was no evidence of an advantage to early repair for small AAA (4.0 cm to 5.5 cm), regardless of whether open repair or EVAR is used and, at least for open repair, regardless of patient age and AAA diameter. Thus, neither early open nor early EVAR of small AAAs is supported by currently available evidence. Long-term data from the two trials investigating EVAR are not available, so, we can only draw firm conclusions regarding outcomes after the first few years for open repair. Research regarding the risks related to and management of small AAAs in ethnic minorities and women is urgently needed, as data regarding these populations are lacking.
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Affiliation(s)
- Pinar Ulug
- Vascular Surgery Research Group, Imperial College London, London, UK
| | - Janet T Powell
- Vascular Surgery Research Group, Imperial College London, London, UK
| | | | - David J Ballard
- Department of Health Policy and Management, UNC Gillings School of Global Public Health, North Carolina, USA
| | - Giovanni Filardo
- Robbins Institute for Health Policy and Leadership, Baylor University, Waco, USA
- Department of Statistical Science, Southern Methodist University, Dallas, USA
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Carter J, Morris D, Sherliker P, Clack R, Lam K, Halliday A. Sex-Specific Associations of Vascular Risk Factors With Abdominal Aortic Aneurysm: Findings From 1.5 Million Women and 0.8 Million Men in the United States and United Kingdom. J Vasc Surg 2020. [DOI: 10.1016/j.jvs.2020.03.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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183
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Abdominal aortic aneurysm screening guidelines: United States Preventative Services Task Force and Society for Vascular Surgery. J Vasc Surg 2020; 71:1457-1458. [DOI: 10.1016/j.jvs.2020.01.054] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Accepted: 01/29/2020] [Indexed: 01/11/2023]
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184
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Carnevale ML, Koleilat I, Lipsitz EC, Friedmann P, Indes JE. Extended screening guidelines for the diagnosis of abdominal aortic aneurysm. J Vasc Surg 2020; 72:1917-1926. [PMID: 32325228 DOI: 10.1016/j.jvs.2020.03.047] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Accepted: 03/16/2020] [Indexed: 11/18/2022]
Abstract
BACKGROUND The U.S. Preventive Services Task Force (USPSTF) guidelines are the most widely used criteria for screening for abdominal aortic aneurysms (AAA). However, when the USPSTF criteria are applied retrospectively to a group of patients who have undergone treatment for AAA, there are many patients who satisfy none of the AAA screening criteria. The more sensitive Society for Vascular Surgery (SVS) guidelines have expanded the criteria for screening for AAA with the hope of capturing a greater fraction of those individuals who can undergo treatment for their AAA before presenting with AAA rupture. We sought to identify the number of patients who would have been identified as having criteria for screening for AAA by both the USPSTF and SVS criteria, in a cohort of patients who have undergone treatment for AAA. METHODS We assessed demographic, comorbidity, and perioperative complication data for all patients undergoing endovascular and open AAA repair in the Vascular Quality Initiative. Patients meeting each of the screening criteria were identified. Clinical factors and demographic variables were collected. RESULTS We identified 55,197 patients undergoing AAA repair in the Vascular Quality Initiative, including 44,602 patients who underwent endovascular aneurysm repair (EVAR) and 10,595 patients undergoing open repair. Of these, the USPTF guidelines would have identified fewer than one-third of patients (32% EVAR and 33% open repair). Applying the SVS guidelines increased the number meeting criteria for screening by 6% and 12% for the EVAR and open repair cohorts, respectively. Finally, adoption of the expanded SVS guidelines (including the "weak recommendations") would have identified an additional 34% of EVAR patients and 21% of open AAA repair patients. Use of the expanded criteria would have resulted in 27% of patients undergoing EVAR and 33% of patients undergoing open AAA repair who would not have met any screening criteria. In EVAR patients not meeting the criteria, 52% were younger than 65 years had a history of heavy smoking. Of all those who did not meet screening criteria, ruptured AAA was twice as prevalent as those who met screening criteria (8.5% vs 4.4%; P ≤ .0001). CONCLUSIONS Expanding established USPSTF screening guidelines to include the expanded SVS criteria may potentially double the number of patients identified with AAA. Smokers under the age of 65, and elderly patients 70 and older with no smoking history, represent two groups with AAA and potentially twice the risk of presenting with rupture.
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Affiliation(s)
- Matthew L Carnevale
- Division of Vascular and Endovascular Surgery, Montefiore Medical Center and The Albert Einstein College of Medicine, Bronx, NY
| | - Issam Koleilat
- Division of Vascular and Endovascular Surgery, Montefiore Medical Center and The Albert Einstein College of Medicine, Bronx, NY
| | - Evan C Lipsitz
- Division of Vascular and Endovascular Surgery, Montefiore Medical Center and The Albert Einstein College of Medicine, Bronx, NY
| | - Patricia Friedmann
- Department of Cardiovascular and Thoracic Surgery, Montefiore Medical Center and The Albert Einstein College of Medicine, Bronx, NY
| | - Jeffrey E Indes
- Division of Vascular and Endovascular Surgery, Montefiore Medical Center and The Albert Einstein College of Medicine, Bronx, NY.
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185
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MacLachlan H, Drezner JA. Cardiac evaluation of young athletes: Time for a risk-based approach? Clin Cardiol 2020; 43:906-914. [PMID: 32242971 PMCID: PMC7403680 DOI: 10.1002/clc.23364] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2019] [Revised: 03/06/2020] [Accepted: 03/13/2020] [Indexed: 12/13/2022] Open
Abstract
Pre‐participation cardiovascular screening (PPCS) is recommended by several scientific and sporting organizations on the premise that early detection of cardiac disease provides a platform for individualized risk assessment and management; which has been proven to lower mortality rates for certain conditions associated with sudden cardiac arrest (SCA) and sudden cardiac death (SCD). What constitutes the most effective strategy for PPCS of young athletes remains a topic of considerable debate. The addition of the electrocardiogram (ECG) to the medical history and physical examination undoubtedly enhances early detection of disease, which meets the primary objective of PPCS. The benefit of enhanced sensitivity must be carefully balanced against the risk of potential harm through increased false‐positive findings, costly downstream investigations, and unnecessary restriction/disqualification from competitive sports. To mitigate this risk, it is essential that ECG‐based PPCS programs are implemented by institutions with a strong infrastructure and by physicians appropriately trained in modern ECG standards with adequate cardiology resources to guide downstream investigations. While PPCS is compulsory for most competitive athletes, the current debate surrounding ECG‐based programs exists in a binary form; whereby ECG screening is mandated for all competitive athletes or none at all. This polarized approach fails to consider individualized patient risk and the available sports cardiology resources. The limitations of a uniform approach are highlighted by evolving data, which suggest that athletes display a differential risk profile for SCA/SCD, which is influenced by age, sex, ethnicity, sporting discipline, and standard of play. Evaluation of the etiology of SCA/SCD within high‐risk populations reveals a disproportionately higher prevalence of ECG‐detectable conditions. Selective ECG screening using a risk‐based approach may, therefore, offer a more cost‐effective and feasible approach to PPCS in the setting of limited sports cardiology resources, although this approach is not without important ethical considerations.
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Affiliation(s)
- Hamish MacLachlan
- Cardiovascular Sciences Research Centre, St Georges University of London, London, UK
| | - Jonathan A Drezner
- Department of Family Medicine and the Center for Sports Cardiology, University of Washington, Seattle, Washington, USA
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