1
|
Farres H, Lanka SP, Nussbaum S, Shoukry M, Hanouneh T, Alexander L, Sella D, Jarmi T. Correlation Between Calcium Scoring and Abdominal Aortic Aneurysm Endovascular Repair Outcomes. Vasc Endovascular Surg 2024:15385744241263696. [PMID: 38886243 DOI: 10.1177/15385744241263696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/20/2024]
Abstract
OBJECTIVES Endovascular aneurysm repair, though minimally invasive and has the benefit of relatively low perioperative complication rates, it is associated with significant long term reintervention rates related to endoleaks. Several variables have been studied to predict the outcomes of endovascular aneurysm repair, 1 of which is the calcium burden of the vasculature. This prompted us to study the association between calcium burden measured by the standardized Agatston scoring system and the outcomes of Endovascular aneurysm repair. METHODS This is a retrospective study of patients who underwent Endovascular aneurysm repair from 2008 to 2020 at our institution and who had a non-contrast computerized tomography scan preoperatively, accounting for 87 patients. The calcium burden of the vasculature was measured by the Agatston scoring system allowing for better reproducibility, and the outcome variables included mortality and endoleaks. RESULTS Patients with higher median total calcium scores (≥12966.9) had significantly lesser survival (79.8% vs 52.3% (P = .002) at five years compared to patients with lower median total calcium score (<12966.9). Also, patients with type 2 endoleaks had higher calcium scores in above the aneurysm level ((1591.2 vs 688.2), P = .05)) compared to patients with no type 2 endoleaks. CONCLUSION Calcium score assigned using a standardized Agatston scoring system can be used as a predictor of mortality risk assisting in deciding the treatment of choice for patients.
Collapse
Affiliation(s)
- Houssam Farres
- Division of Vascular Surgery, Mayo Clinic, Jacksonville, FL, USA
| | | | - Sam Nussbaum
- Division of Oncology, Mayo Clinic, Jacksonville, FL, USA
| | - Mira Shoukry
- Mayo ClinicAlix School of Medicine, Scottsdale, AZ, USA
| | - Tareq Hanouneh
- Division of Transplant Nephrology, Mayo Clinic, Jacksonville, FL, USA
| | | | - David Sella
- Department of Radiology, Mayo Clinic, Jacksonville, FL, USA
| | - Tambi Jarmi
- Division of Transplant Nephrology, Mayo Clinic, Jacksonville, FL, USA
| |
Collapse
|
2
|
Rašiová M, Koščo M, Moščovič M, Habalová V, Židzik J, Tormová Z, Bavoľárová M, Perečinský S, Hudák M, Kočan L, Tkáč I. Positive association between calcium channel blocker treatment and persistent type II endoleak. INT ANGIOL 2022; 41:277-284. [PMID: 35373941 DOI: 10.23736/s0392-9590.22.04847-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Type II endoleaks are the most common complication occuring after endovascular abdominal aortic aneurysm repair (EVAR). The aim of our study was to evaluate the impact of persistent type II endoleak on sac dynamics post-EVAR, and to study the association between non-anatomical factors including polymorphisms associated with abdominal aortic aneurysm (AAA) and persistent type II endoleak. METHODS The cohort comprises of 210 patients undergoing EVAR between January, 2010 and December, 2018. A persistent type II endoleak was defined as any type II endoleak lasting longer than six months and included also a type II endoleak diagnosed after six months or more post-EVAR during the 36-month follow-up period confirmed with CT-angiography. Anteroposterior AAA maximum diameter and AAA volume were measured pre-EVAR and 36 months post-EVAR using CT-angiographic pictures. Sac progression was defined as at least 5 mm increase, sac regression as at least 5 mm decrease in the sac diameter in relation to the preprocedural diameter. Sociodemographic information, comorbidities, treatment, laboratory parameters, selected anatomical and genetic factors were all analysed to determine their impact on persistent type II endoleak. The adjustments included age, hypertension, diabetes mellitus, dyslipidaemia, sex, smoking in multivariate analyses. When postprocedural diameter and volume were evaluated, adjustments included also preprocedural diameter/volume. RESULTS After exclusion, 178 pacients with mean age 72.4±7.60 years remained for analysis. Persistent type II endoleak was found in 27.5% of patients (n=49) and 2.94-times increased risk of sac progression in multivariate analysis (p=0.033). In multivariate analysis, AAA diameter in patients with persistent type II endoleak was 4.31 mm greater than in patients without (B=4.31; p=0.014); and its presence was also associated with 22.0 cm³ greater sac volume (B=22.0; p=0.034) compared to patients without persistent type II endoleak. Treatment with calcium channel blockers increased risk of persistent type II endoleak 2.11-times in multivariate analysis (OR 2.11; 95% CI 1.05-4.25; p=0.037). No association between persistent type II endoleak and selected polymorphisms associated with AAA and other observed factors was found. CONCLUSIONS Risk of persistent type II endoleak was more than doubled in patients taking calcium channel blockers. Patients with persistent type II endoleak had greater anteroposterior sac diameter and sac volume compared to patients without persistent type II endoleak.
Collapse
Affiliation(s)
- Mária Rašiová
- Department of Angiology, East Slovak Institute of Cardiovascular Diseases, Faculty of Medicine, Šafárik University, Košice, Slovakia -
| | - Martin Koščo
- Department of Angiology, East Slovak Institute of Cardiovascular Diseases, Faculty of Medicine, Šafárik University, Košice, Slovakia
| | - Matej Moščovič
- Department of Angiology, East Slovak Institute of Cardiovascular Diseases, Faculty of Medicine, Šafárik University, Košice, Slovakia
| | - Viera Habalová
- Department of Medicine Biology, Faculty of Medicine, Šafárik University, Košice, Slovakia
| | - Jozef Židzik
- Department of Medicine Biology, Faculty of Medicine, Šafárik University, Košice, Slovakia
| | - Zuzana Tormová
- Department of Angiology, East Slovak Institute of Cardiovascular Diseases, Faculty of Medicine, Šafárik University, Košice, Slovakia
| | - Marta Bavoľárová
- Department of Cardiology, Štefan Kukura Hospital, Michalovce, Slovakia
| | - Slavomír Perečinský
- Department of Occupational Medicine and Clinical Toxicology, Faculty of Medicine, Šafárik University, Košice, Slovakia
| | - Marek Hudák
- Department of Angiology, East Slovak Institute of Cardiovascular Diseases, Faculty of Medicine, Šafárik University, Košice, Slovakia
| | - Ladislav Kočan
- Department of Anaesthesiology and Intensive Medicine, East Slovak Institute of Cardiovascular Diseases, Faculty of Medicine, Šafárik University, Košice, Slovakia
| | - Ivan Tkáč
- Department of Internal Medicine 4, Faculty of Medicine, Šafárik University, Košice, Slovakia
| |
Collapse
|
3
|
Significance of preoperative thrombus burden in the prediction of persistent Type II endoleak and re-intervention following infra-renal EVAR. J Vasc Surg 2022; 75:1912-1917. [PMID: 34995721 DOI: 10.1016/j.jvs.2021.12.069] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Accepted: 12/19/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND Persistent Type II endoleak has necessitated prolonged surveillance and is a reason for re-intervention following infra-renal endovascular aneurysm repair (EVAR). The aim of this study was to assess the association of thrombus burden (TB) within the aneurysmal sac in the prediction of persistent Type II endoleaks. METHODS Consecutive patients undergoing infra-renal EVAR from October 2009 to October 2017 in a single vascular network were included. TB was assessed on preoperative CT-angiogram and was defined as a percentage of thrombus across the maximal sac diameter in comparison to the luminal diameter measured orthogonally at the same level. Patients were categorised into 3 groups; Low TB (<25%), Medium TB (25%-50%) and High TB (>50%). All patients underwent postoperative EVAR surveillance comprising of computed tomographic angiography or duplex ultrasound. Type II endoleak observed for more than one year was defined as persistent Type II endoleak. Odds ratio and Student's T-test were used to determine significance. RESULTS Some 275 EVARs were performed in the study period. 45 procedures were excluded due to either iliac-only intervention (n=9), no pre-operative information (n=7), abandoned (n=1) or less than 1 year's follow-up data (n=28). For the 230 procedures included, the median follow-up was 43 (12-102) months. There were no significant differences between the groups for age, gender, co-morbidities nor preoperative sac diameter. There was high inter-observer reliability with a kappa value of 0.89 (0.84-0.94) with a total discordance of 7% across the cohorts. Persistent Type II endoleak occurred significantly more frequently with reduced TB: 41% of the low TB cohort compared with 4% of the high TB cohort [OR 15.36 (3.5-67.3) p=0.0003]. Re-intervention was also significantly more likely to occur in the presence of a persistent Type II endoleak compared to its absence; n=12/13 (92%) patients who underwent re-intervention had a persistent Type II endoleak [OR 43.4 (5.5-242) p=0.0003]. Sac size reduction was significantly greater in medium TB and high TB cohorts when compared to low TB; -25% and -27% vs. -15% (p=0.0046 and p<0.0001). Decreased TB was associated with a significant increase in Inferior Mesenteric Artery (IMA) patency; the mean TB, where the IMA was patent, being 29% compared to 40% where the IMA was occluded p<0.0001. When considered together, patients with a low TB and a patent IMA were even more likely to have a persistent Type II endoleak when compared to those with a high TB and an occluded IMA; [OR 34.1 (1.99-583) p=0.015]. CONCLUSION Low thrombus burden is associated with increased rates of persistent Type II endoleak, especially in the presence of a patent IMA. High thrombus burden is associated with increased sac regression and low re-intervention rates. Thrombus burden can be assessed reliably and could be used for risk stratification in the planning of infra-renal EVAR. Pre-emptive embolization of IMA or lumbar vessels in those with low thrombus burden may be beneficial. Thrombus burden could be a useful tool for designing post-EVAR surveillance regimen.
Collapse
|
4
|
DIAS-NETO M, NEVES E, SOUSA-NUNES F, HENRIQUES-COELHO T, SAMPAIO S. Abdominal aortic aneurysm calcification: trying to identify a reliable semiquantitative method. THE JOURNAL OF CARDIOVASCULAR SURGERY 2021; 62:51-58. [DOI: 10.23736/s0021-9509.18.10132-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
|
5
|
Li Z, Zhao Z, Cai Z, Sun Y, Li L, Yao F, Yang L, Zhou Y, Zhu H, Fu Y, Wang L, Fang W, Chen Y, Kong W. Runx2 (Runt-Related Transcription Factor 2)-Mediated Microcalcification Is a Novel Pathological Characteristic and Potential Mediator of Abdominal Aortic Aneurysm. Arterioscler Thromb Vasc Biol 2020; 40:1352-1369. [PMID: 32212850 DOI: 10.1161/atvbaha.119.314113] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
OBJECTIVE Abdominal aortic aneurysms (AAAs) are highly lethal diseases without effective clinical predictors and therapeutic targets. Vascular microcalcification, as detected by fluorine-18-sodium fluoride, has recently been recognized as a valuable indicator in predicting atherosclerotic plaque rupture and AAA expansion. However, whether vascular microcalcification involved in the pathogenesis of AAA remains elusive. Approach and Results: Microcalcification was analyzed in human aneurysmal aortas histologically and in AngII (angiotensin II)-infused ApoE-/- mouse aortas by fluorine-18-sodium fluoride positron emission tomography and X-ray computed tomography scanning in chronological order in live animals. AAA patients' aortic tissue showed markedly enhanced microcalcification in the aortic media within the area proximal to elastic fiber degradation, compared with non-AAA patients. Enhanced fluorine-18-sodium fluoride uptake preceded significant aortic expansion in mice. Microcalcification-positive mice on day 7 of AngII infusion showed dramatic aortic expansion on subsequent days 14 to 28, whereas microcalcification-negative AngII-infused mice and saline-induced mice did not develop AAA. The application of hydroxyapatite, the main component of microcalcification, aggravated AngII-induced AAA formation in vivo. RNA-sequencing analysis of the suprarenal aortas of 4-day-AngII-infused ApoE-/- mice and bioinformatics analysis with ChIP-Atlas database identified the potential involvement of the osteogenic transcriptional factor Runx2 (runt-related transcription factor 2) in AAA. Consistently, vascular smooth muscle cell-specific Runx2 deficiency markedly repressed AngII-induced AAA formation in the ApoE-/- mice compared with the control littermates. CONCLUSIONS Our studies have revealed microcalcification as a novel pathological characteristic and potential mediator of AAA, and targeting microcalcification may represent a promising strategy for AAA prevention and treatment.
Collapse
Affiliation(s)
- Zhiqing Li
- Department of Physiology and Pathophysiology, School of Basic Medical Sciences, Peking University, Key Laboratory of Molecular Cardiovascular Science, Ministry of Education, China (Z.L., Z.C., L.Y., Y.F., W.K.)
| | - Zuoquan Zhao
- Department of Nuclear Medicine (Z.Z., W.F.), Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing
| | - Zeyu Cai
- Department of Physiology and Pathophysiology, School of Basic Medical Sciences, Peking University, Key Laboratory of Molecular Cardiovascular Science, Ministry of Education, China (Z.L., Z.C., L.Y., Y.F., W.K.)
| | - Yong Sun
- Department of Pathology, University of Alabama at Birmingham (Y.S., Y.C.)
| | - Li Li
- Department of Pathology, State Key Laboratory of Cardiovascular Disease (L.L.), Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing
| | - Fang Yao
- State Key Laboratory of Cardiovascular Disease (F.Y., L.W.), Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing
| | - Liu Yang
- Department of Physiology and Pathophysiology, School of Basic Medical Sciences, Peking University, Key Laboratory of Molecular Cardiovascular Science, Ministry of Education, China (Z.L., Z.C., L.Y., Y.F., W.K.)
| | - Yuan Zhou
- Department of Biomedical Informatics, School of Basic Medical Sciences, Peking University, Beijing, China (Y.Z.)
| | - Haibo Zhu
- Fuwai Hospital, National Center for Cardiovascular Diseases, and State Key Laboratory for Bioactive Substances and Functions of Natural Medicines, Beijing Key Laboratory of New Drug Mechanisms and Pharmacological Evaluation Study, Institute of Materia Medica (H.Z.), Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing
| | - Yi Fu
- Department of Physiology and Pathophysiology, School of Basic Medical Sciences, Peking University, Key Laboratory of Molecular Cardiovascular Science, Ministry of Education, China (Z.L., Z.C., L.Y., Y.F., W.K.)
| | - Li Wang
- State Key Laboratory of Cardiovascular Disease (F.Y., L.W.), Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing
| | - Wei Fang
- Department of Nuclear Medicine (Z.Z., W.F.), Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing
| | - Yabing Chen
- Department of Pathology, University of Alabama at Birmingham (Y.S., Y.C.)
| | - Wei Kong
- Department of Physiology and Pathophysiology, School of Basic Medical Sciences, Peking University, Key Laboratory of Molecular Cardiovascular Science, Ministry of Education, China (Z.L., Z.C., L.Y., Y.F., W.K.)
| |
Collapse
|
6
|
Skrebunas A, Lengvenis G, Builyte IU, Zulpaite R, Bliudzius R, Baltrunas T, Misonis N, Marinskis G. Aortic sac enlargement after endovascular aneurysm repair: volume-related changes and the impact of intraluminal thrombus. Pol J Radiol 2019; 84:e530-e536. [PMID: 32082451 PMCID: PMC7016495 DOI: 10.5114/pjr.2019.91260] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Accepted: 11/06/2019] [Indexed: 11/17/2022] Open
Abstract
PURPOSE Abdominal aortic aneurysm (AAA) growth after endovascular aneurysm repair (EVAR) is still unpredictable. The issue of optimal frequency of computed tomography angiography for surveillance and its measurement method accuracy remain unclear. We aimed to assess the value of abdominal aneurysm sac volume measurement for detecting expansions and the association of preprocedural intraluminal thrombus (ILT) volume with aneurysm sac growth following EVAR. MATERIAL AND METHODS A total of 107 patients underwent elective EVAR. Inclusion criteria provided a cohort of 39 patients. Changes of postoperative maximum aneurysm sac diameter and AAA volume were calculated. Volumetric AAA changes and demographic data of the cases with clinically irrelevant AAA diameter enlargement were evaluated. Preoperative ILT volumes were collected. ILT and AAA sac volume ratio was calculated. Statistical data analysis was performed using standard methods. RESULTS The mean changes of maximum AAA diameter and volume in percentage after EVAR were -5.08 ± 8.20 mm and -13.39 ± 23.32%, respectively. A moderate positive linear correlation between those changes was found (R 2 = 0.731; p < 0.0001). The mean relative AAA volume increase in cases without clinically relevant diameter enlargement was 11.50 ± 8.27%. The means of ILT and AAA sac ratios were 0.59 ± 0.17 and 0.52 ± 1.8 in growing AAA sac and in stable or shrinking AAA sac groups, respectively (p = 0.308). CONCLUSIONS Volumetric AAA measurement may be useful as an additional method to diameter measurement after EVAR to identify clinically relevant sac growth. Preoperative volume of ILT may not significantly affect the growth rate of AAA after EVAR.
Collapse
Affiliation(s)
- Arminas Skrebunas
- Clinic of Cardiovascular Diseases, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
- Centre of Cardiology and Angiology, Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania
| | - Givi Lengvenis
- Centre of Cardiology and Angiology, Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania
| | - Inga Urte Builyte
- Clinic of Cardiovascular Diseases, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Ruta Zulpaite
- Clinic of Cardiovascular Diseases, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Rytis Bliudzius
- Centre of Radiology and Nuclear Medicine, Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania
| | - Tomas Baltrunas
- Clinic of Cardiovascular Diseases, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
- Centre of Cardiology and Angiology, Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania
| | - Nerijus Misonis
- Clinic of Cardiovascular Diseases, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
- Centre of Cardiology and Angiology, Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania
| | - Germanas Marinskis
- Clinic of Cardiovascular Diseases, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
- Centre of Cardiology and Angiology, Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania
| |
Collapse
|
7
|
New predictors of aneurysm sac behavior after endovascular aortic aneurysm repair. Eur Radiol 2019; 29:6591-6599. [PMID: 31250171 DOI: 10.1007/s00330-019-06306-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Revised: 05/07/2019] [Accepted: 06/05/2019] [Indexed: 12/18/2022]
Abstract
OBJECTIVES This study aimed to identify new predictors of sac behavior after endovascular aortic aneurysm repair (EVAR) and to investigate whether sac behavior is associated with long-term clinical outcomes. METHODS A total of 168 patients undergoing successful EVAR for abdominal aortic aneurysms with CTA follow-up of at least 1 year were included. Predictors of aneurysm sac behavior and its impact on long-term clinical outcomes were retrospectively analyzed. RESULTS According to sac behavior, eligible patients were stratified into the sac regression group (n = 79, 47.0%) and the sac non-regression group (n = 89, 53.0%). Patients in the regression group were younger (p = 0.036) and more likely to take sarpogrelate hydrochloride postoperatively (p = 0.011) than those in the non-regression group. The incidence of postimplantation syndrome (PIS) was significantly higher in the regression group (p = 0.005). On multivariate analysis, sac regression was more likely to occur in those with PIS (hazard ratio [HR], 1.68; 95% confidence interval [CI], 1.07-2.64; p = 0.023) and less likely to occur in those with transient type II endoleaks (HR, 0.43; 95% CI, 0.20-0.95; p = 0.037) and higher thrombus density within the sac on follow-up CTA (HR, 0.97; 95% CI, 0.95-0.99; p = 0.013). Non-regression of the sac was associated with significantly higher rates of re-intervention during the follow-up period (p = 0.001). CONCLUSIONS In addition to type II endoleaks, PIS and thrombus density are new predictors of aneurysm sac behavior, and sac regression is significantly associated with lower rates of re-intervention. KEY POINTS • After endovascular aortic aneurysm repair (EVAR), patients with sac regression were younger and more likely to take sarpogrelate hydrochloride postoperatively than those with sac non-regression. • The incidence of postimplantation syndrome (PIS) was significantly higher in patients with sac regression. • In our analysis, PIS and thrombus density within the sac were newly identified predictors of aneurysm sac behavior after EVAR.
Collapse
|
8
|
Li B, Montbriand J, Eisenberg N, Roche-Nagle G, Tan KT, Byrne J. Pre-operative Aneurysm Thrombus Volume, But Not Density, Predicts Type 2 Endoleak Rate Following Endovascular Aneurysm Repair. Ann Vasc Surg 2018; 57:98-108. [PMID: 30500629 DOI: 10.1016/j.avsg.2018.09.012] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Revised: 07/25/2018] [Accepted: 09/21/2018] [Indexed: 11/17/2022]
Abstract
BACKGROUND The impact of aneurysm thrombus characteristics on type 2 endoleak rate following endovascular aneurysm repair (EVAR) for abdominal aortic aneurysm (AAA) is unclear. The purpose of this study is to determine the impact of pre-operative aneurysm thrombus volume and density on the incidence of type 2 endoleak following EVAR for infrarenal AAA. METHODS A retrospective analysis was completed on all patients who underwent standard EVAR at an academic medical institution between May 1, 2010 and June 1, 2016 with a minimum follow-up period of 12 months. The final analysis included 170 patients. Thrombus volume and density were determined by analyzing pre-operative computed tomography angiography (CTA) scans using the TeraRecon plaque analysis module. The number and diameter of patent infrarenal aortic branch vessels were also identified. Type 2 endoleak was diagnosed by post-operative CTA, duplex ultrasound, or angiography. RESULTS Over a median follow-up period of 29 months, 88 (51.8%) of 170 patients had a type 2 endoleak. The thrombus volume as a proportion of the infrarenal aorta volume was significantly lower in patients with type 2 endoleak (odds ratio [OR] 0.034, 95% confidence interval [CI] 0.005-0.291, P = 0.002). The number of patent lumbar arteries was significantly greater in patients with type 2 endoleak (OR 1.45, 95% CI 1.16-1.56, P < 0.0005). Both variables independently predicted the incidence of type 2 endoleak in a multivariate analysis. Thrombus density was not related to the incidence of type 2 endoleak. CONCLUSIONS A lower ratio of thrombus volume/infrarenal aorta volume and a higher number of patent lumbar arteries were associated with an increased incidence of type 2 endoleak. A multivariate logistic regression model was generated to pre-operatively predict the risk of type 2 endoleak. This model can guide the stratification of patients for intensity of endoleak surveillance following EVAR and consideration of pre-operative treatment.
Collapse
Affiliation(s)
- Ben Li
- Division of Vascular Surgery, Department of Surgery, Toronto General Hospital, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Janice Montbriand
- Division of Vascular Surgery, Department of Surgery, Toronto General Hospital, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Naomi Eisenberg
- Division of Vascular Surgery, Department of Surgery, Toronto General Hospital, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Graham Roche-Nagle
- Division of Vascular Surgery, Department of Surgery, Toronto General Hospital, University Health Network, University of Toronto, Toronto, ON, Canada; Division of Vascular and Interventional Radiology, Department of Medical Imaging, Toronto General Hospital, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Kong Teng Tan
- Division of Vascular and Interventional Radiology, Department of Medical Imaging, Toronto General Hospital, University Health Network, University of Toronto, Toronto, ON, Canada
| | - John Byrne
- Division of Vascular Surgery, Department of Surgery, Toronto General Hospital, University Health Network, University of Toronto, Toronto, ON, Canada.
| |
Collapse
|
9
|
Rowbotham SE, Pinchbeck JL, Anderson G, Bourke B, Bourke M, Gasser TC, Jaeggi R, Jenkins JS, Moran CS, Morton SK, Reid CM, Velu R, Yip L, Moxon JV, Golledge J. Inositol in the MAnaGemENt of abdominal aortic aneurysm (IMAGEN): study protocol for a randomised controlled trial. Trials 2017; 18:547. [PMID: 29145894 PMCID: PMC5692794 DOI: 10.1186/s13063-017-2304-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Accepted: 10/31/2017] [Indexed: 12/20/2022] Open
Abstract
Background An abdominal aortic aneurysm (AAA) is a focal dilation of the abdominal aorta and is associated with a risk of fatal rupture. Experimental studies suggest that myo-inositol may exert beneficial effects on AAAs through favourable changes to biological pathways implicated in AAA pathology. The aim of the Inositol in the MAnaGemENt of abdominal aortic aneurysm (IMAGEN) trial is to assess if myo-inositol will reduce AAA growth. Methods/design IMAGEN is a multi-centre, prospective, parallel-group, randomised, double-blind, placebo-controlled trial. A total of 164 participants with an AAA measuring ≥ 30 mm will be randomised to either 2 g of myo-inositol or identical placebo twice daily for 12 months. The primary outcome measure will be AAA growth estimated by increase in total infrarenal aortic volume measured on computed tomographic scans. Secondary outcome measures will include AAA diameter assessed by computed tomography and ultrasound, AAA peak wall stress and peak wall rupture index, serum lipids, circulating AAA biomarkers, circulating RNAs and health-related quality of life. All analysis will be based on the intention-to-treat principle at the time of randomisation. All patients who meet the eligibility criteria, provide written informed consent and are enrolled in the study will be included in the primary analysis, regardless of adherence to dietary allocation. Discussion Currently, there is no known medical therapy to limit AAA progression. The IMAGEN trial will be the first randomised trial, to our knowledge, to assess the value of myo-inositol in limiting AAA growth. Trial registration Australian New Zealand Clinical Trials Registry, ACTRN12615001209583. Registered on 6 November 2015. Electronic supplementary material The online version of this article (doi:10.1186/s13063-017-2304-x) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Sophie E Rowbotham
- School of Medicine, The University of Queensland, Herston, QLD, 4006, Australia.,Department of Vascular Surgery, The Royal Brisbane and Women's Hospital, Herston, QLD, 4029, Australia.,Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, James Cook University, Townsville, QLD, 4811, Australia
| | - Jenna L Pinchbeck
- Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, James Cook University, Townsville, QLD, 4811, Australia
| | - Georgina Anderson
- Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, James Cook University, Townsville, QLD, 4811, Australia
| | - Bernie Bourke
- Gosford Vascular Services, Gosford, NSW, 2250, Australia
| | - Michael Bourke
- Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, James Cook University, Townsville, QLD, 4811, Australia.,Gosford Vascular Services, Gosford, NSW, 2250, Australia
| | - T Christian Gasser
- Department of Solid Mechanics, School of Engineering Sciences, KTH Royal Institute of Technology, 100 44, Stockholm, Sweden
| | - Rene Jaeggi
- Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, James Cook University, Townsville, QLD, 4811, Australia
| | - Jason S Jenkins
- Department of Vascular Surgery, The Royal Brisbane and Women's Hospital, Herston, QLD, 4029, Australia
| | - Corey S Moran
- Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, James Cook University, Townsville, QLD, 4811, Australia
| | - Susan K Morton
- Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, James Cook University, Townsville, QLD, 4811, Australia
| | - Christopher M Reid
- School of Public Health, Curtin University, Perth, WA, 6000, Australia.,School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, 3004, Australia
| | - Ramesh Velu
- Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, James Cook University, Townsville, QLD, 4811, Australia.,Department of Vascular and Endovascular Surgery, The Townsville Hospital, Townsville, QLD, 4811, Australia
| | - Lisan Yip
- Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, James Cook University, Townsville, QLD, 4811, Australia
| | - Joseph V Moxon
- Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, James Cook University, Townsville, QLD, 4811, Australia
| | - Jonathan Golledge
- Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, James Cook University, Townsville, QLD, 4811, Australia. .,Department of Vascular and Endovascular Surgery, The Townsville Hospital, Townsville, QLD, 4811, Australia.
| |
Collapse
|
10
|
Assessment of Competence in EVAR Stent Graft Sizing and Selection. Eur J Vasc Endovasc Surg 2017; 53:844-852. [DOI: 10.1016/j.ejvs.2017.03.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2016] [Accepted: 03/07/2017] [Indexed: 12/20/2022]
|
11
|
Müller-Wille R, Güntner O, Zeman F, Dollinger M, Hälg C, Beyer LP, Pfister K, Kasprzak P, Stroszczynski C, Wohlgemuth WA. The Influence of Preoperative Aneurysmal Thrombus Quantity and Distribution on the Development of Type II Endoleaks with Aneurysm Sac Enlargement After EVAR of AAA. Cardiovasc Intervent Radiol 2016; 39:1099-109. [PMID: 27307180 DOI: 10.1007/s00270-016-1386-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2016] [Accepted: 05/23/2016] [Indexed: 10/21/2022]
Abstract
PURPOSE To determine the influence of preoperative aneurysmal thrombus quantity and distribution on the development of type II endoleak with aneurysm sac enlargement after endovascular aneurysm repair (EVAR). MATERIALS AND METHODS We retrospectively analyzed the pre- and postoperatively performed CT scans of 118 patients who had follow-up imaging for at least 1 year after EVAR available. We assessed preoperative thrombus perimeter (T Peri), diameter (T Dia), cross-sectional area (T CSA), and volume (T Vol). The preoperative thrombus distribution was classified into no thrombus, semilunar-shaped (anterior, right side, left side, posterior) thrombus, and circumferential type thrombus. The number of preoperative patent aortic side branches (ASB) was identified. Endpoint was type II endoleak with aneurysm volume (A Vol) increase of ≥5 % during follow-up. RESULTS During follow-up (2 years, range 1-9 years), 17 patients with type II endoleak had significant A Vol increase. Less preoperative T Peri, T Dia, T CSA, and T Vol were associated with A Vol increase. A circumferential thrombus distribution significantly protected against aneurysm enlargement (p = 0.028). The variables with the strongest significance for A Vol increase were preoperative T Vol/A Vol ratio (OR 0.95; p = 0.037) and number of patent ASB (OR 3.52; p < 0.001). CONCLUSION A low preoperative T Vol/A Vol ratio and a high number of patent ASB were associated with aneurysm sac enlargement after EVAR.
Collapse
Affiliation(s)
- R Müller-Wille
- Department of Radiology, University Medical Center Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany.
| | - O Güntner
- Dr. Neumaier MVZ GmBH Castra Regina Center, Bahnhofstraße 24, 93047, Regensburg, Germany
| | - F Zeman
- Center for Clinical Studies, University Medical Center Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany
| | - M Dollinger
- Department of Diagnostic and Interventional Radiology, University Hospital of Würzburg, Oberdürrbacher Str. 6, 97080, Würzburg, Germany
| | - C Hälg
- Department of Radiology and Nuclear Medicine, Kantonsspital Schaffhausen, Geissbergstrasse 81, 8208, Schaffhausen, Switzerland
| | - L P Beyer
- Department of Radiology, University Medical Center Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany
| | - K Pfister
- Department of Vascular Surgery, University Medical Center Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany
| | - P Kasprzak
- Department of Vascular Surgery, University Medical Center Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany
| | - C Stroszczynski
- Department of Radiology, University Medical Center Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany
| | - W A Wohlgemuth
- Department of Radiology, University Medical Center Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany
| |
Collapse
|
12
|
Sirignano P, Menna D, Capoccia L, Montelione N, Mansour W, Rizzo AR, Sbarigia E, Speziale F. Preoperative Intrasac Thrombus Load Predicts Worse Outcome after Elective Endovascular Repair of Abdominal Aortic Aneurysms. J Vasc Interv Radiol 2015; 26:1431-6. [DOI: 10.1016/j.jvir.2015.07.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2014] [Revised: 07/02/2015] [Accepted: 07/04/2015] [Indexed: 11/24/2022] Open
|
13
|
Multimodality imaging assessment of the deleterious role of the intraluminal thrombus on the growth of abdominal aortic aneurysm in a rat model. Eur Radiol 2015; 26:2378-86. [PMID: 26396112 DOI: 10.1007/s00330-015-4010-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2015] [Revised: 08/31/2015] [Accepted: 09/03/2015] [Indexed: 01/08/2023]
Abstract
OBJECTIVES To evaluate imaging changes occurring in a rat model of elastase-induced abdominal aortic aneurysm (AAA), with emphasis on the intraluminal thrombus (ILT) occurrence. METHODS The post-induction growth of the AAA diameter was characterized using ultrasound in 22 rats. ILT was reported on 13 rats that underwent 14 magnetic resonance imaging (MRI) 2-18 days post-surgery, and on 10 rats that underwent 18 fluoro-deoxyglucose (FDG) positron emission tomography (PET)/microcomputed tomography examinations 2-27 days post-surgery. Logistic regressions were used to establish the evolution with time of AAA length, diameter, ILT thickness, volume, stratification, MRI and FDG PET signalling properties, and histological assessment of inflammatory infiltrates. RESULTS All of the following significantly increased with time post-induction (p < 0.001): AAA length, AAA diameter, ILT maximal thickness, ILT volume, ILT iron content and related MRI signalling changes, quantitative uptake on FDG PET, and the magnitude of inflammatory infiltrates on histology. However, the aneurysm growth peak followed occurrence of ILT approximately 6 days after elastase infusion. CONCLUSION Our model emphasizes that occurrence of ILT precedes AAA peak growth. Aneurysm growth is associated with increasing levels of iron, signalling properties changes in both MRI and FDG PET, relating to its biological activities. KEY POINTS • ILT occurrence in AAA is associated with increasing FDG uptake and growth. • MRI signalling changes in ILT reflect activities such as haemorrhage and RBC trapping. • Monitoring ILT activities using MRI may require no exogenous contrast agent.
Collapse
|
14
|
Nomura Y, Sugimoto K, Gotake Y, Yamanaka K, Sakamoto T, Muradi A, Okada T, Yamaguchi M, Okita Y. Comparison of Volumetric and Diametric Analysis in Endovascular Repair of Descending Thoracic Aortic Aneurysm. Eur J Vasc Endovasc Surg 2015; 50:53-9. [DOI: 10.1016/j.ejvs.2015.02.021] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2014] [Accepted: 02/26/2015] [Indexed: 11/25/2022]
|
15
|
Li Y, Zhang T, Guo W, Duan C, Wei R, Ge Y, Jia X, Liu X. Endovascular chimney technique for juxtarenal abdominal aortic aneurysm: a systematic review using pooled analysis and meta-analysis. Ann Vasc Surg 2015; 29:1141-50. [PMID: 26004962 DOI: 10.1016/j.avsg.2015.02.015] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2014] [Revised: 02/09/2015] [Accepted: 02/13/2015] [Indexed: 12/20/2022]
Abstract
BACKGROUND To evaluate the safety and efficacy of chimney endovascular abdominal aortic repair (Ch-EVAR) for juxtarenal abdominal aortic aneurysm. METHODS Electronic literature published between 2003 and 2014 were searched from MEDLINE and EMBASE online databases. Inclusion criteria for articles included that more than 3 patients were enrolled, chimney graft techniques were used, and the basic outcomes, such as indications, mortality within 30-day or during follow-up, complications, endoleaks, and branch vessel patency were collected. The data were pooled for analysis. Meta-analysis was performed using Stata version 11 and heterogeneity was estimated using Cochrane Q statistic and I(2) statistic. RESULTS In total, 12 electronic literature met the inclusion criteria and 236 patients (mean age, 73.9 years) undergone Ch-EVAR were collected. A total of 335 chimney grafts were implanted, including 288 to the renal arteries and 47 to superior mesenteric arteries. Mortality (<30 days) and mortality (during follow-up; a mean of 12 months) were 3.8% (9/236) and 10.6% (25/236), respectively. The rate of type I, II and III endoleaks during follow-up was 11.8% (28/236), 8.1% (19/236), and 0.4% (1/236), respectively. The chimney graft patency at 6 month was 96.6%. Meta-analysis showed that the rates of endoleaks (during follow-up), mortality (<30 days) and mortality (during follow-up) were 18%, 7% and 13%, respectively. CONCLUSIONS Chimney graft is an efficient therapy with high initial technical success rate and favorable rates for perioperative outcomes.
Collapse
Affiliation(s)
- Yue Li
- Clinical Division of Surgery, Department of Vascular Surgery, Chinese PLA General Hospital, Beijing, People's Republic of China
| | - Tao Zhang
- Department of Vascular Surgery, Peking University People's Hospital, Beijing, People's Republic of China
| | - Wei Guo
- Clinical Division of Surgery, Department of Vascular Surgery, Chinese PLA General Hospital, Beijing, People's Republic of China.
| | - Chen Duan
- Clinical Division of Surgery, Department of Vascular Surgery, Chinese PLA General Hospital, Beijing, People's Republic of China
| | - Ren Wei
- Clinical Division of Surgery, Department of Vascular Surgery, Chinese PLA General Hospital, Beijing, People's Republic of China
| | - Yangyang Ge
- Clinical Division of Surgery, Department of Vascular Surgery, Chinese PLA General Hospital, Beijing, People's Republic of China
| | - Xin Jia
- Clinical Division of Surgery, Department of Vascular Surgery, Chinese PLA General Hospital, Beijing, People's Republic of China
| | - Xiaoping Liu
- Clinical Division of Surgery, Department of Vascular Surgery, Chinese PLA General Hospital, Beijing, People's Republic of China
| |
Collapse
|