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Zhang L, Yang H, Zhou C, Li Y, Long Z, Li Q, Zhang J, Qin X. Artificial intelligence-driven multiomics predictive model for abdominal aortic aneurysm subtypes to identify heterogeneous immune cell infiltration and predict disease progression. Int Immunopharmacol 2024; 138:112608. [PMID: 38981221 DOI: 10.1016/j.intimp.2024.112608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2024] [Revised: 06/23/2024] [Accepted: 06/29/2024] [Indexed: 07/11/2024]
Abstract
BACKGROUND Abdominal aortic aneurysm (AAA) poses a significant health risk and is influenced by various compositional features. This study aimed to develop an artificial intelligence-driven multiomics predictive model for AAA subtypes to identify heterogeneous immune cell infiltration and predict disease progression. Additionally, we investigated neutrophil heterogeneity in patients with different AAA subtypes to elucidate the relationship between the immune microenvironment and AAA pathogenesis. METHODS This study enrolled 517 patients with AAA, who were clustered using k-means algorithm to identify AAA subtypes and stratify the risk. We utilized residual convolutional neural network 200 to annotate and extract contrast-enhanced computed tomography angiography images of AAA. A precise predictive model for AAA subtypes was established using clinical, imaging, and immunological data. We performed a comparative analysis of neutrophil levels in the different subgroups and immune cell infiltration analysis to explore the associations between neutrophil levels and AAA. Quantitative polymerase chain reaction, Western blotting, and enzyme-linked immunosorbent assay were performed to elucidate the interplay between CXCL1, neutrophil activation, and the nuclear factor (NF)-κB pathway in AAA pathogenesis. Furthermore, the effect of CXCL1 silencing with small interfering RNA was investigated. RESULTS Two distinct AAA subtypes were identified, one clinically more severe and more likely to require surgical intervention. The CNN effectively detected AAA-associated lesion regions on computed tomography angiography, and the predictive model demonstrated excellent ability to discriminate between patients with the two identified AAA subtypes (area under the curve, 0.927). Neutrophil activation, AAA pathology, CXCL1 expression, and the NF-κB pathway were significantly correlated. CXCL1, NF-κB, IL-1β, and IL-8 were upregulated in AAA. CXCL1 silencing downregulated NF-κB, interleukin-1β, and interleukin-8. CONCLUSION The predictive model for AAA subtypes demonstrated accurate and reliable risk stratification and clinical management. CXCL1 overexpression activated neutrophils through the NF-κB pathway, contributing to AAA development. This pathway may, therefore, be a therapeutic target in AAA.
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Affiliation(s)
- Lin Zhang
- The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, PR China
| | - Han Yang
- The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, PR China
| | - Chenxing Zhou
- The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, PR China
| | - Yao Li
- Liuzhou People's Hospital, Liuzhou, Guangxi, PR China
| | - Zhen Long
- The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, PR China
| | - Que Li
- The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, PR China
| | - Jiangfeng Zhang
- The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, PR China
| | - Xiao Qin
- The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, PR China.
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Dong H, Leach JR, Kao E, Zhou A, Chitiboi T, Zhu C, Ballweber M, Jiang F, Lee YJ, Iannuzzi J, Gasper W, Saloner D, Hope MD, Mitsouras D. Measurement of Abdominal Aortic Aneurysm Strain Using MR Deformable Image Registration: Accuracy and Relationship to Recent Aneurysm Progression. Invest Radiol 2024; 59:425-432. [PMID: 37855728 PMCID: PMC11026303 DOI: 10.1097/rli.0000000000001035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2023]
Abstract
BACKGROUND Management of asymptomatic abdominal aortic aneurysm (AAA) based on maximum aneurysm diameter and growth rate fails to preempt many ruptures. Assessment of aortic wall biomechanical properties may improve assessment of progression and rupture risk. This study aimed to assess the accuracy of AAA wall strain measured by cine magnetic resonance imaging (MRI) deformable image registration (MR strain) and investigate its relationship with recent AAA progression. METHODS The MR strain accuracy was evaluated in silico against ground truth strain in 54 synthetic MRIs generated from a finite element model simulation of an AAA patient's abdomen for different aortic pulse pressures, tissue motions, signal intensity variations, and image noise. Evaluation included bias with 95% confidence interval (CI) and correlation analysis. Association of MR strain with AAA growth rate was assessed in 25 consecutive patients with >6 months of prior surveillance, for whom cine balanced steady-state free-precession imaging was acquired at the level of the AAA as well as the proximal, normal-caliber aorta. Univariate and multivariate regressions were used to associate growth rate with clinical variables, maximum AAA diameter (D max ), and peak circumferential MR strain through the cardiac cycle. The MR strain interoperator variability was assessed using bias with 95% CI, intraclass correlation coefficient, and coefficient of variation. RESULTS In silico experiments revealed an MR strain bias of 0.48% ± 0.42% and a slope of correlation to ground truth strain of 0.963. In vivo, AAA MR strain (1.2% ± 0.6%) was highly reproducible (bias ± 95% CI, 0.03% ± 0.31%; intraclass correlation coefficient, 97.8%; coefficient of variation, 7.14%) and was lower than in the nonaneurysmal aorta (2.4% ± 1.7%). D max ( β = 0.087) and MR strain ( β = -1.563) were both associated with AAA growth rate. The MR strain remained an independent factor associated with growth rate ( β = -0.904) after controlling for D max . CONCLUSIONS Deformable image registration analysis can accurately measure the circumferential strain of the AAA wall from standard cine MRI and may offer patient-specific insight regarding AAA progression.
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Affiliation(s)
- Huiming Dong
- From the Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA (H.D., J.L., E.K., A.Z., C.Z., M.B., Y.J.L., D.S., M.H., D.M.); Vascular Imaging Research Center, San Francisco Veteran Affairs Medical Center, San Francisco, CA (H.D., J.L., E.K., A.Z., C.Z., M.B., D.S., M.H., D.M.); Siemens Healthineers (T.C.); Department of Radiology, University of Washington, Seattle, WA (C.Z.); Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA (F.J.); Department of Surgery, University of California, San Francisco, San Francisco, CA (J.I., W. G.); and Department of Vascular Surgery, San Francisco Veteran Affairs Medical Center, San Francisco, CA (J.I., W.G.)
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Prendes CF, Gouveia E Melo R, Caldeira D, D'Oria M, Tsilimparis N, Koelemay M, Van Herzeele I, Wanhainen A. Editor's Choice - Systematic Review and Meta-Analysis of Contemporary Abdominal Aortic Aneurysm Growth Rates. Eur J Vasc Endovasc Surg 2024; 67:132-145. [PMID: 37777049 DOI: 10.1016/j.ejvs.2023.09.039] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 08/17/2023] [Accepted: 09/21/2023] [Indexed: 10/02/2023]
Abstract
OBJECTIVE To evaluate the contemporary growth rate of small abdominal aortic aneurysms (AAAs) in view of recent epidemiological changes, such as decreasing smoking rates and establishment of population screening programmes. DATA SOURCES MEDLINE, CENTRAL, PsycINFO, Web of Science Core Collection, and OpenGrey databases. REVIEW METHODS Systematic review following the PRISMA guidelines. In October 2021, databases were queried for studies reporting on AAA growth rates published from 2015 onwards. The primary outcome was contemporary AAA growth rates in mm/year. Data were pooled in a random effects model meta-analysis, and heterogeneity was assessed through the I2 statistic. GRADE assessment of the findings was performed. The protocol was published in PROSPERO (CRD42022297404). RESULTS Of 8 717 titles identified, 43 studies and 28 277 patients were included: 1 241 patients from randomised controlled trials (RCTs), 23 941 from clinical observational studies, and 3 095 from radiological or translational research studies. The mean AAA growth rate was 2.38 mm/year (95% CI 2.16 - 2.60 mm/year; GRADE = low), with meta-regression analysis adjusted for baseline diameter showing an increase of 0.08 mm/year (95% CI 0.024 - 0.137 mm/year; p = .005) for each millimetre of increased baseline diameter. When analysed by study type, the growth rate estimated from RCTs was 1.88 mm/year (95% CI 1.69 - 2.06 mm/year; GRADE = high), while it was 2.31 mm/year (95% CI 1.95 - 2.67 mm/year; GRADE = moderate) from clinical observational studies, and 2.85 mm/year (95% CI 2.44 - 3.26 mm/year; GRADE = low) from translational and radiology based studies (p < .001). Heterogeneity was high, and small study publication bias was present (p = .003), with 27 studies presenting a moderate to high risk of bias. The estimated growth rate from low risk studies was 2.09 mm/year (95% CI 1.87 - 2.32; GRADE = high). CONCLUSION This study estimated a contemporaneous AAA growth rate of 2.38 mm/year, being unable to demonstrate any clinically meaningful AAA growth rate reduction concomitant with changed AAA epidemiology. This suggests that the RESCAN recommendations on small AAA surveillance are still valid. However, sub-analysis results from RCTs and high quality study data indicate potential lower AAA growth rates of 1.88 - 2.09 mm/year, findings that should be validated in a high quality prospective registry.
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Affiliation(s)
- Carlota F Prendes
- Department of Vascular Surgery, Ludwig Maximilians University Hospital, Munich, Germany.
| | - Ryan Gouveia E Melo
- Vascular Surgery Department, Hospital Santa Maria, Centro Hospitalar Universitário Lisboa Norte (CHULN), Centro Cardiovascular da Universidade de Lisboa (CCUL@RISE), Faculdade de Medicina da Universidade de Lisboa, Centro Académico de Medicina de Lisboa, Lisbon, Portugal
| | - Daniel Caldeira
- Cardiology Department, Hospital Santa Maria, Centro Hospitalar Universitário Lisboa Norte (CHULN), Centro Cardiovascular da Universidade de Lisboa (CCUL@RISE), Centro de Estudos de Medicina Baseada na Evidência (CEMB), Faculdade de Medicina da Universidade de Lisboa, Centro Académico de Medicina de Lisboa, Lisbon, Portugal
| | - Mario D'Oria
- Division of Vascular and Endovascular Surgery, Cardiovascular Department, University Hospital of Trieste ASUGI, Trieste, Italy
| | - Nikolaos Tsilimparis
- Department of Vascular Surgery, Ludwig Maximilians University Hospital, Munich, Germany
| | - Mark Koelemay
- Department of Surgery, Amsterdam UMC, location AMC, University of Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, the Netherlands
| | - Isabelle Van Herzeele
- Department of Thoracic and Vascular Surgery, Ghent University Hospital, Ghent, Belgium
| | - Anders Wanhainen
- Department of Surgical Sciences, Section of Vascular Surgery, Uppsala, Sweden; Department of Peri-operative and Surgical Sciences, Section of Surgery, Umeå University, Umeå, Sweden
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Kindon AJ, McCombie AM, Frampton C, Khashram M, Clarke G, Roake J. Early Relative Growth Rate of Abdominal Aortic Aneurysms and Future Risk of Rupture or Repair. Eur J Vasc Endovasc Surg 2023; 66:797-803. [PMID: 37567340 DOI: 10.1016/j.ejvs.2023.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 07/27/2023] [Accepted: 08/04/2023] [Indexed: 08/13/2023]
Abstract
OBJECTIVE This study aimed to test whether the relative growth rate of subthreshold abdominal aortic aneurysms (AAAs) in the first 24 months of surveillance predicts the risk of future rupture or repair. METHODS This was a single centre retrospective observational analysis of all small (< 45 mm diameter) and medium (45 - 54 mm in men, 45 - 50 mm in women) AAAs entered into ultrasound surveillance between January 2002 and December 2019, which received ≥ 24 months of surveillance. Relative growth rates were calculated from measurements taken in the first 24 months of surveillance. The Kaplan-Meier method was used to estimate intervention and rupture free proportions five years following diagnosis for AAAs growing by < 5% and by ≥ 5% in the first 24 months of surveillance. Multivariable Cox regression analysis was used to further analyse this relationship by adjusting for factors found to be significantly associated with outcome in univariable analysis. RESULTS A total of 556 patients with AAAs (409 men, 147 women) were followed for ≥ 24 months. This included 431 small AAAs. Of these, 109 (25.3%) grew by < 5% in the first 24 months of surveillance and had a cumulative event free proportion of 0.98 ± 0.05 at five years compared with 0.78 ± 0.05 for the ≥ 5% growth group (p < .001). Of 125 medium AAAs, 26 (20.8%) grew by < 5% in the first 24 months of surveillance and had a cumulative event free proportion of 0.73 ± 0.11 at five years compared with 0.29 ± 0.13 for the ≥ 5% growth group (p = .024). Baseline diameter and early relative growth rate were strongly and independently predictive of future intervention or rupture with hazard ratios of 9.16 (95% CI 5.98 - 14.03, p < .001) and 4.46 (95% CI 2.45 - 8.14, p < .001), respectively. CONCLUSION The results suggest that slow expansion of small (< 45 mm) AAAs observed over an isolated 24 month period is indicative of a very low risk of rupture or repair in the medium term. Isolated growth rates may be a useful tool with which to triage low risk AAAs and prevent unnecessary surveillance.
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Affiliation(s)
- Andrew J Kindon
- Geo-Health Laboratory, University of Canterbury, New Zealand; Department of Radiology, Christchurch Public Hospital, Canterbury District Health Board, New Zealand; Christchurch Vascular Group, Christchurch, New Zealand.
| | | | | | - Manar Khashram
- Department of Surgery, University of Auckland, Auckland, New Zealand; Department of Vascular Surgery, Waikato Hospital, Hamilton, New Zealand
| | - Glynnis Clarke
- Department of Vascular, Endovascular & Transplant Surgery, Christchurch Public Hospital, Christchurch, New Zealand
| | - Justin Roake
- Christchurch Vascular Group, Christchurch, New Zealand; Department of Surgery, University of Otago, New Zealand; Department of Vascular, Endovascular & Transplant Surgery, Christchurch Public Hospital, Christchurch, New Zealand
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Zhou A, Leach JR, Zhu C, Dong H, Jiang F, Lee YJ, Iannuzzi J, Gasper W, Saloner D, Hope MD, Mitsouras D. Dynamic Contrast-Enhanced MRI in Abdominal Aortic Aneurysms as a Potential Marker for Disease Progression. J Magn Reson Imaging 2023; 58:1258-1267. [PMID: 36747321 DOI: 10.1002/jmri.28640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 01/24/2023] [Accepted: 01/26/2023] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Abdominal aortic aneurysms (AAAs) may rupture before reaching maximum diameter (Dmax ) thresholds for repair. Aortic wall microvasculature has been associated with elastin content and rupture sites in specimens, but its relation to progression is unknown. PURPOSE To investigate whether dynamic contrast-enhanced (DCE) MRI of AAA is associated with Dmax or growth. STUDY TYPE Prospective. POPULATION A total of 27 male patients with infrarenal AAA (mean age ± standard deviation = 75 ± 5 years) under surveillance with DCE MRI and 2 years of prior follow-up intervals with computed tomography (CT) or MRI. FIELD STRENGTH/SEQUENCE A 3-T, dynamic three-dimensional (3D) fast gradient-echo stack-of-stars volumetric interpolated breath-hold examination (Star-VIBE). ASSESSMENT Wall voxels were manually segmented in two consecutive slices at the level of Dmax . We measured slope to 1-minute and area under the curve (AUC) to 1 minute and 4 minutes of the signal intensity change postcontrast relative to that precontrast arrival, and, Ktrans , a measure of microvascular permeability, using the Patlak model. These were averaged over all wall voxels for association to Dmax and growth rate, and, over left/right and anterior/posterior quadrants for testing circumferential homogeneity. Dmax was measured orthogonal to the aortic centerline and growth rate was calculated by linear fit of Dmax measurements. STATISTICAL TESTS Pearson correlation and linear mixed effects models. A P value <0.05 was considered statistically significant. RESULTS In 44 DCE MRIs, mean Dmax was 45 ± 7 mm and growth rate in 1.5 ± 0.4 years of prior follow-up was 1.7 ± 1.2 mm per year. DCE measurements correlated with each other (Pearson r = 0.39-0.99) and significantly differed between anterior/posterior versus left/right quadrants. DCE measurements were not significantly associated with Dmax (P = 0.084, 0.289, 0.054 and 0.255 for slope, AUC at 1 minute and 4 minutes, and Ktrans , respectively). Slope and 4 minutes AUC significantly associated with growth rate after controlling for Dmax . CONCLUSION Contrast uptake may be increased in lateral aspects of the AAA. Contrast enhancement 1-minute slope and 4-minutes AUC may be associated with a period of recent AAA growth that is independent of Dmax . EVIDENCE LEVEL 3. TECHNICAL EFFICACY Stage 2.
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Affiliation(s)
- Ang Zhou
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California, USA
- San Francisco Veterans Affairs Medical Center, San Francisco, California, USA
| | - Joseph R Leach
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California, USA
- San Francisco Veterans Affairs Medical Center, San Francisco, California, USA
| | - Chengcheng Zhu
- Department of Radiology, University of Washington, Seattle, Washington, USA
| | - Huiming Dong
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California, USA
- San Francisco Veterans Affairs Medical Center, San Francisco, California, USA
| | - Fei Jiang
- Department of Biostatistics, University of California San Francisco, San Francisco, California, USA
| | - Yoo Jin Lee
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California, USA
| | - James Iannuzzi
- San Francisco Veterans Affairs Medical Center, San Francisco, California, USA
- Department of Surgery, University of California San Francisco, San Francisco, California, USA
| | - Warren Gasper
- San Francisco Veterans Affairs Medical Center, San Francisco, California, USA
- Department of Surgery, University of California San Francisco, San Francisco, California, USA
| | - David Saloner
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California, USA
- San Francisco Veterans Affairs Medical Center, San Francisco, California, USA
| | - Michael D Hope
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California, USA
- San Francisco Veterans Affairs Medical Center, San Francisco, California, USA
| | - Dimitrios Mitsouras
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California, USA
- San Francisco Veterans Affairs Medical Center, San Francisco, California, USA
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Contrast-enhanced CT radiomics improves the prediction of abdominal aortic aneurysm progression. Eur Radiol 2023; 33:3444-3454. [PMID: 36920519 DOI: 10.1007/s00330-023-09490-7] [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: 07/25/2022] [Revised: 12/06/2022] [Accepted: 01/27/2023] [Indexed: 03/16/2023]
Abstract
OBJECTIVES To determine if three-dimensional (3D) radiomic features of contrast-enhanced CT (CECT) images improve prediction of rapid abdominal aortic aneurysm (AAA) growth. METHODS This longitudinal cohort study retrospectively analyzed 195 consecutive patients (mean age, 72.4 years ± 9.1) with a baseline CECT and a subsequent CT or MR at least 6 months later. 3D radiomic features were measured for 3 regions of the AAA, viz. the vessel lumen only; the intraluminal thrombus (ILT) and aortic wall only; and the entire AAA sac (lumen, ILT, and wall). Multiple machine learning (ML) models to predict rapid growth, defined as the upper tercile of observed growth (> 0.25 cm/year), were developed using data from 60% of the patients. Diagnostic accuracy was evaluated using the area under the receiver operating characteristic curve (AUC) in the remaining 40% of patients. RESULTS The median AAA maximum diameter was 3.9 cm (interquartile range [IQR], 3.3-4.4 cm) at baseline and 4.4 cm (IQR, 3.7-5.4 cm) at the mean follow-up time of 3.2 ± 2.4 years (range, 0.5-9 years). A logistic regression model using 7 radiomic features of the ILT and wall had the highest AUC (0.83; 95% confidence interval [CI], 0.73-0.88) in the development cohort. In the independent test cohort, this model had a statistically significantly higher AUC than a model including maximum diameter, AAA volume, and relevant clinical factors (AUC = 0.78, 95% CI, 0.67-0.87 vs AUC = 0.69, 95% CI, 0.57-0.79; p = 0.04). CONCLUSION A radiomics-based method focused on the ILT and wall improved prediction of rapid AAA growth from CECT imaging. KEY POINTS • Radiomic analysis of 195 abdominal CECT revealed that an ML-based model that included textural features of intraluminal thrombus (if present) and aortic wall improved prediction of rapid AAA progression compared to maximum diameter. • Predictive accuracy was higher when radiomic features were obtained from the thrombus and wall as opposed to the entire AAA sac (including lumen), or the lumen alone. • Logistic regression of selected radiomic features yielded similar accuracy to predict rapid AAA progression as random forests or support vector machines.
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Paraskevas KI, Spence JD, Mikhailidis DP, Antignani PL, Gloviczki P, Eckstein HH, Spinelli F, Stilo F, Saba L, Poredos P, Dardik A, Liapis CD, Mansilha A, Faggioli G, Pini R, Jezovnik MK, Sultan S, Musiałek P, Goudot G, Lavenson GS, Jawien A, Blinc A, Myrcha P, Fernandes E Fernandes J, Geroulakos G, Kakkos SK, Knoflach M, Proczka RM, Capoccia L, Rundek T, Svetlikov AS, Silvestrini M, Ricco JB, Davies AH, Di Lazzaro V, Suri JS, Lanza G, Fraedrich G, Zeebregts CJ, Nicolaides AN. Why do guidelines recommend screening for abdominal aortic aneurysms, but not for asymptomatic carotid stenosis? A plea for a randomized controlled trial. Int J Cardiol 2023; 371:406-412. [PMID: 36162523 DOI: 10.1016/j.ijcard.2022.09.045] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 09/18/2022] [Accepted: 09/20/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Current guidelines do not recommend screening for asymptomatic carotid artery stenosis (AsxCS). The rationale behind this recommendation is that detection of AsxCS may lead to an unnecessary carotid intervention. In contrast, screening for abdominal aortic aneurysms is strongly recommended. METHODS A critical analysis of the literature was performed to evaluate the implications of detecting AsxCS. RESULTS Patients with AsxCS are at high risk for future stroke, myocardial infarction and vascular death. Population-wide screening for AsxCS should not be recommended. Additionally, screening of high-risk individuals for AsxCS with the purpose of identifying candidates for a carotid intervention is inappropriate. Instead, selective screening for AsxCS should be considered and should be viewed as an opportunity to identify individuals at high risk for atherosclerotic cardiovascular disease and future cardiovascular events for the timely initiation of intensive medical therapy and risk factor modification. CONCLUSIONS Although mass screening should not be recommended, there are several arguments suggesting that selective screening for AsxCS should be considered. The rationale supporting such selective screening is to optimize risk factor control and to initiate intensive medical therapy for prevention of future cardiovascular events, rather than to identify candidates for an intervention.
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Affiliation(s)
| | - J David Spence
- Stroke Prevention and Atherosclerosis Research Centre, Robarts Research Institute, Western University, London, ON, Canada
| | - Dimitri P Mikhailidis
- Department of Clinical Biochemistry, Royal Free Hospital Campus, University College London Medical School, University College London (UCL), London, UK
| | | | - Peter Gloviczki
- Division of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, MN, USA
| | - Hans-Henning Eckstein
- Department for Vascular and Endovascular Surgery, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Francesco Spinelli
- Vascular Surgery Division, Campus Bio-Medico University of Rome, Rome, Italy
| | - Francesco Stilo
- Vascular Surgery Division, Campus Bio-Medico University of Rome, Rome, Italy
| | - Luca Saba
- Department of Radiology, Azienda Ospedaliera Universitaria Di Cagliari, Cagliari, Italy
| | - Pavel Poredos
- Department of Vascular Disease, University Medical Centre Ljubljana, Slovenia
| | - Alan Dardik
- Division of Vascular and Endovascular Surgery, Yale University School of Medicine, New Haven, CT, USA
| | | | - Armando Mansilha
- Faculty of Medicine of the University of Porto, Porto, Portugal; Department of Angiology and Vascular Surgery, Hospital de S. Joao, Porto, Portugal
| | - Gianluca Faggioli
- Vascular Surgery, University of Bologna "Alma Mater Studiorum", Policlinico S. Orsola Malpighi, Bologna, Italy
| | - Rodolfo Pini
- Vascular Surgery, University of Bologna "Alma Mater Studiorum", Policlinico S. Orsola Malpighi, Bologna, Italy
| | - Mateja K Jezovnik
- Department of Advanced Cardiopulmonary Therapies and Transplantation, The University of Texas Health Science Centre at Houston, Houston, TX, USA
| | - Sherif Sultan
- Western Vascular Institute, Department of Vascular and Endovascular Surgery, University Hospital Galway, National University of Ireland, Galway, Ireland
| | - Piotr Musiałek
- Jagiellonian University Department of Cardiac and Vascular Diseases, John Paul II Hospital, Krakow, Poland
| | - Guillaume Goudot
- Vascular medicine department, Georges Pompidou European hospital, APHP, Université de Paris Cité, Paris, France
| | - George S Lavenson
- Department of Surgery, Uniformed Services University, Bethesda, MD, USA
| | - Arkadiusz Jawien
- Department of Vascular Surgery and Angiology, Collegium Medicum, Nicolaus Copernicus University, Bydgoszcz, Poland
| | - Aleš Blinc
- Department of Vascular Diseases, Division of Internal Medicine, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Piotr Myrcha
- Department of General and Vascular Surgery, Faculty of Medicine, Medical University of Warsaw, Warsaw, Poland
| | | | - George Geroulakos
- Department of Vascular Surgery, "Attikon" University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Stavros K Kakkos
- Department of Vascular Surgery, University Hospital of Patras, Patras, Greece
| | - Michael Knoflach
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Robert M Proczka
- 1(st) Department of Vascular Surgery, Medicover Hospital, Warsaw, Poland
| | - Laura Capoccia
- Department of Surgery "Paride Stefanini", Policlinico Umberto I, "Sapienza" University of Rome, Rome, Italy
| | - Tatjana Rundek
- Department of Neurology, Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Alexei S Svetlikov
- Division of Vascular and Endovascular Surgery, North-Western Scientific Clinical Center of Federal Medical Biological Agency of Russia, St. Petersburg, Russia
| | - Mauro Silvestrini
- Neurological Clinic, Department of Experimental and Clinical Medicine, Marche Polytechnic University, Ancona, Italy
| | - Jean-Baptiste Ricco
- Department of Clinical Research, University of Poitiers, CHU de Poitiers, Poitiers, France
| | - Alun H Davies
- Department of Surgery and Cancer, Section of Vascular Surgery, Imperial College London, Charing Cross Hospital, London, UK
| | - Vincenzo Di Lazzaro
- Neurology, Neurophysiology and Neurobiology Unit, Department of Medicine, Universita Campus Bio-Medico di Roma, Rome, Italy
| | - Jasjit S Suri
- Stroke Diagnostic and Monitoring Division, Atheropoint™, Roseville, CA, USA
| | - Gaetano Lanza
- Vascular Surgery Department, IRCSS Multimedica Hospital, Castellanza, Italy
| | - Gustav Fraedrich
- Department of Vascular Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Clark J Zeebregts
- Department of Surgery (Division of Vascular Surgery), University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Andrew N Nicolaides
- Department of Surgery, University of Nicosia Medical School, Nicosia, Cyprus
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Wong KHF, Zlatanovic P, Bosanquet DC, Saratzis A, Kakkos SK, Aboyans V, Twine CP. Antithrombotic Therapy for Aortic Aneurysms: A Systematic Review and Meta-Analysis. Eur J Vasc Endovasc Surg 2022; 64:544-556. [PMID: 35853579 DOI: 10.1016/j.ejvs.2022.07.008] [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: 02/05/2022] [Revised: 06/25/2022] [Accepted: 07/10/2022] [Indexed: 01/12/2023]
Abstract
OBJECTIVES The role of antithrombotic therapy in the management of aortic and peripheral aneurysms is unclear. This systematic review and meta-analysis aimed to assess the impact of antithrombotics on clinical outcomes for aortic and peripheral aneurysms. METHODS Medline, Embase, and CENTRAL databases were searched. Randomised controlled trials and observational studies investigating the effect of antithrombotic therapy on clinical outcomes for patients with any aortic or peripheral artery aneurysm were included. RESULTS Fifty-nine studies (28 with antiplatelet agents, 12 anticoagulants, two intra-operative heparin, and 16 any antithrombotic agent) involving 122 102 patients were included. Abdominal aortic aneurysm (AAA) growth rate was not significantly associated with the use of antiplatelet therapy (SMD -0.36 mm/year; 95% CI -0.75 - 0.02; p = .060; GRADE certainty: very low). Antithrombotics were associated with increased 30 day mortality for patients with AAAs undergoing intervention (OR 2.30; 95% CI 1.51 - 3.51; p < .001; GRADE certainty: low). Following intervention, antiplatelet therapy was associated with reduced long term all cause mortality (HR 0.84; 95% CI 0.76 - 0.92; p < .001; GRADE certainty: moderate), whilst anticoagulants were associated with increased all cause mortality (HR 1.64; 95% CI 1.14 - 2.37; p = .008; GRADE certainty: very low), endoleak within three years (OR 1.99; 95% CI 1.10 - 3.60; p = .020; I2 = 60%; GRADE certainty: very low), and an increased re-intervention rate at one year (OR 3.25; 95% CI 1.82 - 5.82; p < .001; I2 = 35%; GRADE certainty: moderate). Five studies examined antithrombotic therapy for popliteal aneurysms. Meta-analysis was not possible due to heterogeneity. CONCLUSIONS There was a lack of high quality data examining antithrombotic therapy for patients with aneurysms. Antiplatelet therapy was associated with a reduction in post-intervention all cause mortality for AAA, whilst anticoagulants were associated with an increased risk of all cause mortality, endoleak, and re-intervention. Large, well designed trials are still required to determine the therapeutic benefits of antithrombotic agents in this setting.
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Affiliation(s)
- Kitty H F Wong
- Bristol Centre for Surgical Research, Bristol Medical School, University of Bristol, Bristol, UK; North Bristol NHS Trust, Bristol, UK
| | - Petar Zlatanovic
- Clinic for Vascular and Endovascular Surgery, Clinical Centre of Serbia, Belgrade, Serbia
| | | | | | - Stavros K Kakkos
- Department of Vascular Surgery, University of Patras Medical School, Patras, Greece
| | - Victor Aboyans
- Department of Cardiology, Dupuytren University Hospital, EpiMaCT, Inserm 1094 & IRD, Limoges University, Limoges, France
| | - Christopher P Twine
- Bristol Centre for Surgical Research, Bristol Medical School, University of Bristol, Bristol, UK; North Bristol NHS Trust, Bristol, UK.
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9
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Treska V, Molacek J, Certik B, Houdek K, Hosek P, Soukupova V, Stogerova C, Svejdova A. Management of Concomitant Abdominal Aortic Aneurysm and Intra-abdominal, Retroperitoneal Malignancy. In Vivo 2021; 35:517-523. [PMID: 33402504 DOI: 10.21873/invivo.12286] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 10/29/2020] [Accepted: 11/03/2020] [Indexed: 11/10/2022]
Abstract
BACKGROUND/AIM As the population ages, there are increasing findings of coincidental diseases such as abdominal aortic aneurysm (AAA) and intra-abdominal, retroperitoneal malignancy. The aim of this study was to propose an optimal treatment procedure for these patients. PATIENTS AND METHODS Over a twenty-year-period, surgery was performed on a total of 1,098 patients with AAA and 32 (2.9%) patients with AAA and intra-abdominal, retroperitoneal malignancy: 18 renal, 6 colorectal carcinomas, 3 carcinomas of the small intestine, 3 primary liver tumours, 1 stomach carcinoma and 1 teratoma. The median age of patients was 72.5 years, there were 20 men (62.5%) and 12 women (37.5%). A one-stage procedure was performed on 19 patients (59.4%), and a two-stage procedure on 13 (40.6%) patients. RESULTS The average time of hospitalization was 12.4±6.9 days (median=11.0 days) for one-stage procedure, for a two-stage procedure 21.3±9.3 days (median=20.0 days), p=0.0045. Seven patients (21.9%) died within 30 days after the operation. All the deaths were in the group of one-stage procedures (p=0.0252). The 1-, 3- and 5-year overall survival for patients following one-stage and twostage procedures was 61.0/56.3/51.5% and 89.0/79.9/53.0% respectively (p=0.1199). CONCLUSION Symptomatic disease must be resolved first. Two-stage procedures are the method of choice and offer better short-term results compared to one-stage procedures.
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Affiliation(s)
- Vladislav Treska
- Department of Surgery, School of Medicine in Pilsen, Charles University in Prague, Prague, Prague, Czech Republic;
| | - Jiri Molacek
- Department of Surgery, School of Medicine in Pilsen, Charles University in Prague, Prague, Prague, Czech Republic
| | - Bohuslav Certik
- Department of Surgery, School of Medicine in Pilsen, Charles University in Prague, Prague, Prague, Czech Republic
| | - Karel Houdek
- Department of Surgery, School of Medicine in Pilsen, Charles University in Prague, Prague, Prague, Czech Republic
| | - Petr Hosek
- Biomedicine Center, School of Medicine, Pilsen, Czech Republic
| | - Veronika Soukupova
- Department of Surgery, School of Medicine in Pilsen, Charles University in Prague, Prague, Prague, Czech Republic
| | - Christiana Stogerova
- Department of Surgery, School of Medicine in Pilsen, Charles University in Prague, Prague, Prague, Czech Republic
| | - Aneta Svejdova
- Department of Surgery, School of Medicine in Pilsen, Charles University in Prague, Prague, Prague, Czech Republic
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10
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Abstract
Abdominal aortic aneurysms (AAA) are prevalent among older adults and can cause significant morbidity and mortality if not addressed in a timely fashion. Their etiology remains the topic of continued investigation. Known causes include trauma, infection, and inflammatory disorders. Risk factors include cigarette smoking, advanced age, dyslipidemia, hypertension, and coronary artery disease. The pathophysiology of the disease is related to an initial arterial insult causing a cascade of inflammation and extracellular matrix protein breakdown by proteinases leading to arterial wall weakening. When identified early, aneurysms must be monitored for size, growth rate, and other factors which could increase the risk of rupture. Factors predisposing to rupture include size, active smoking, rate of growth, aberrant biomechanical properties of the aneurysmal sac, and female sex. Medical management includes the control of risk factors that may prevent growth, stabilize the aneurysm, and prevent rupture. Surgical management prevents rupture of high risk aneurysms, most commonly predicted by size. Less frequently, surgical management is required when the aneurysm has ruptured. Surgery involves a multidisciplinary approach to evaluate the patient's risk profile and to develop an operative plan involving either an endovascular or an open surgical repair. The patient must be carefully monitored post-operatively for complications and, in the case of endovascular repairs, for endoleaks. AAA management has evolved rapidly in recent years. Technical and technological advances have transformed the diagnosis and treatment of this disease.
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Affiliation(s)
- John Anagnostakos
- Center for Vascular Research, University of Maryland, United States of America
| | - Brajesh K Lal
- Center for Vascular Research, University of Maryland, United States of America; University of Maryland, United States of America; Endovascular Surgery, University of Maryland Medical Center, United States of America; Baltimore VA Medical Center, United States of America.
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11
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McLenon M, Okuhn S, Lancaster EM, Hull MM, Adams JL, McGlynn E, Avins AL, Chang RW. Validation of natural language processing to determine the presence and size of abdominal aortic aneurysms in a large integrated health system. J Vasc Surg 2021; 74:459-466.e3. [PMID: 33548429 DOI: 10.1016/j.jvs.2020.12.090] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Accepted: 12/23/2020] [Indexed: 01/31/2023]
Abstract
OBJECTIVE Previous studies of the natural history of abdominal aortic aneurysms (AAAs) have been limited by small cohort sizes or heterogeneous analyses of pooled data. By quickly and efficiently extracting imaging data from the health records, natural language processing (NLP) has the potential to substantially improve how we study and care for patients with AAAs. The aim of the present study was to test the ability of an NLP tool to accurately identify the presence or absence of AAAs and detect the maximal abdominal aortic diameter in a large dataset of imaging study reports. METHODS Relevant imaging study reports (n = 230,660) from 2003 to 2017 were obtained for 32,778 patients followed up in a prospective aneurysm surveillance registry within a large, diverse, integrated healthcare system. A commercially available NLP algorithm was used to assess the presence of AAAs, confirm the absence of AAAs, and extract the maximal diameter of the abdominal aorta, if stated. A blinded expert manual review of 18,000 randomly selected imaging reports was used as the reference standard. The positive predictive value (PPV or precision), sensitivity (recall), and the kappa statistics were calculated. RESULTS Of the randomly selected 18,000 studies that underwent expert manual review, 48.7% were positive for AAAs. In confirming the presence of an AAA, the interrater reliability of the NLP compared with the expert review showed a kappa value of 0.84 (95% confidence interval [CI], 0.83-0.85), with a PPV of 95% and sensitivity of 88.5%. The NLP algorithm showed similar results for confirming the absence of an AAA, with a kappa of 0.79 (95% CI, 0.799-0.80), PPV of 77.7%, and sensitivity of 91.9%. The kappa, PPV, and sensitivity of the NLP for correctly identifying the maximal aortic diameter was 0.88 (95% CI, 0.87-0.89), 88.8%, and 88.2% respectively. CONCLUSIONS The use of NLP software can accurately analyze large volumes of radiology report data to detect AAA disease and assemble a contemporary aortic diameter-based cohort of patients for longitudinal analysis to guide surveillance, medical management, and operative decision making. It can also potentially be used to identify from the electronic medical records pre- and postoperative AAA patients "lost to follow-up," leverage human resources engaged in the ongoing surveillance of patients with AAAs, and facilitate the construction and implementation of AAA screening programs.
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Affiliation(s)
| | - Steven Okuhn
- Division of Vascular Surgery, Department of Surgery, Veterans Affairs San Francisco Healthcare System, San Francisco, Calif; Division of Vascular Surgery, Department of Surgery, University of California, San Francisco, San Francisco, Calif
| | - Elizabeth M Lancaster
- Division of Vascular Surgery, Department of Surgery, University of California, San Francisco, San Francisco, Calif
| | - Michaela M Hull
- Kaiser Permanente Center for Effectiveness and Safety Research, Pasadena, Calif
| | - John L Adams
- Kaiser Permanente Center for Effectiveness and Safety Research, Pasadena, Calif
| | - Elizabeth McGlynn
- Kaiser Permanente Center for Effectiveness and Safety Research, Pasadena, Calif
| | - Andrew L Avins
- Division of Research, Kaiser Permanente Northern California, Oakland, Calif; Department of Medicine, University of California, San Francisco, San Francisco, Calif; Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, Calif
| | - Robert W Chang
- Division of Research, Kaiser Permanente Northern California, Oakland, Calif; Division of Vascular Surgery, Department of Surgery, The Permanente Medical Group, South San Francisco, Calif.
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12
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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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13
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Rockley M, Radonjic A, LeBlanc D, Jetty P. The futility of surveillance for old and small aneurysms. J Vasc Surg 2020; 72:162-170.e1. [DOI: 10.1016/j.jvs.2019.09.063] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Accepted: 09/27/2019] [Indexed: 12/30/2022]
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14
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Mitsouras D, Leach JR. Expanding the Radiologist's Arsenal against Abdominal Aortic Aneurysms, a Versatile Adversary. Radiology 2020; 295:730-732. [PMID: 32233921 PMCID: PMC7263282 DOI: 10.1148/radiol.2020200531] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2020] [Revised: 02/22/2020] [Accepted: 02/24/2020] [Indexed: 11/11/2022]
Affiliation(s)
- Dimitrios Mitsouras
- From the Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, Calif; and Department of Radiology, Veterans Affairs Medical Center, 4150 Clement St, 114D, San Francisco, CA 94121
| | - Joseph R. Leach
- From the Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, Calif; and Department of Radiology, Veterans Affairs Medical Center, 4150 Clement St, 114D, San Francisco, CA 94121
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15
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Paraskevas KI, Eckstein HH, Mikhailidis DP, Veith FJ, Spence JD. Rationale for screening selected patients for asymptomatic carotid artery stenosis. Curr Med Res Opin 2020; 36:361-365. [PMID: 31910676 DOI: 10.1080/03007995.2020.1713075] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Stroke is a leading cause of death and disability worldwide. Approximately 15% of all first-ever strokes occur due to atheroembolism from a previously undetected/untreated asymptomatic carotid stenosis (ACS). Despite that, international guidelines do not recommend screening for ACS. The rationale for not recommending screening include: (a) the harm associated with screening, (b) the questionable clinical benefit associated with surgery, (c) the lack of proven reduction in the risk of stroke, (d) the large number of false positive/false negative tests, and (e) the cost-effectiveness of such screening programs. A critical analysis of each of these arguments is presented. Patients with ACS have a very high risk of all-cause and cardiac mortality. Detection of ACS should not be viewed as an indication for surgery, but rather as an opportunity to implement best medical treatment (BMT) and lifestyle changes to prevent not only strokes, but also cardiac events. The implementation of screening programs for abdominal aortic aneurysms (AAAs) has led to a considerable reduction in the number of ruptured AAAs and AAA-related deaths. Similarly, screening high-risk individuals for ACS would enable timely identification of patients with ACS and implementation of BMT and lifestyle measures to prevent future strokes and cardiac events.
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Affiliation(s)
- Kosmas I Paraskevas
- Department of Vascular Surgery, "Attikon" University Hospital, Athens, Greece
| | - Hans-Henning Eckstein
- Department for Vascular and Endovascular Surgery, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Dimitri P Mikhailidis
- Department of Clinical Biochemistry, Royal Free Hospital Campus, University College London, London, UK
| | - Frank J Veith
- Departments of Vascular Surgery, Langone Medical Center, New York University, New York, NY, USA
- The Cleveland Clinic, Cleveland, OH, USA
| | - J David Spence
- Stroke Prevention & Atherosclerosis Research Centre, Robarts Research Institute, Western University, London, Canada
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16
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Radonjic A, Fat Hing NN, Harlock J, Naji F. YouTube as a source of patient information for abdominal aortic aneurysms. J Vasc Surg 2019; 71:637-644. [PMID: 31611104 DOI: 10.1016/j.jvs.2019.08.230] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2019] [Accepted: 08/11/2019] [Indexed: 10/25/2022]
Abstract
OBJECTIVE Patients are increasingly referring to the Internet after a diagnosis of vascular disease. This study was performed to quantitatively define the accuracy and reliability of information on YouTube regarding abdominal aortic aneurysms (AAA). METHODS A systematic search of YouTube was conducted using multiple AAA-specific keywords. The default YouTube search setting of "relevance" was used to replicate an average search attempt, and the first 50 results from each keyword search were reviewed and analyzed by two independent reviewers. Descriptive characteristics, Journal of the American Medical Association Score, modified DISCERN score, Video Power Index, and a novel scoring system for the management of AAAs, the AAA-Specific Score (AAASS), were used to record data. Inter-rater agreement was analyzed using intraclass correlation coefficient estimates and the Kruskal-Wallis test was used for intergroup comparisons. RESULTS Fifty-one videos were included for analysis. The mean Journal of the American Medical Association Score, DISCERN, and AAASS values among videos were 1.74/4.00 (standard deviation [SD], 0.84), 2.37/5.00 (SD, 0.97), and 6.63/20.00 (SD, 3.23), respectively. Of all the included videos, 78% were educational in nature, 14% were patient testimonials, and 8% were news programs. Based on the AAASS, the majority of analyzed videos fell into the poor category (41%), followed next by the very poor (31%), moderately useful (25%), very useful (2%), and exceptional (0%) categories. Videos by nonphysicians were significantly more popular (P < .05) than vascular surgeon sources. CONCLUSIONS Although variable in source and content, the completeness and reliability of information offered on YouTube for AAA diagnosis and treatment is poor. Patients watching YouTube for information on their AAA diagnosis are receiving an incomplete and perhaps misleading picture of available diagnostic and treatment options. Given that vascular surgeons are likely to be affected by unrealistic treatment expectations from patients accessing online materials regarding AAA, it is important to acknowledge the nature of content on these platforms.
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Affiliation(s)
| | | | - John Harlock
- Division of Vascular Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Faysal Naji
- Division of Vascular Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
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17
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Paraskevas KI, Eckstein HH, Schermerhorn ML. Guideline Recommendations for the Management of Abdominal Aortic Aneurysms. Angiology 2019; 70:688-689. [DOI: 10.1177/0003319719825518] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
| | - Hans-Henning Eckstein
- Department of Vascular and Endovascular Surgery, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Marc L. Schermerhorn
- Division of Vascular and Endovascular Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
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18
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Paraskevas KI. Aortic wall inflammation: a more accurate predictor of aneurysm expansion and aneurysm rupture risk than aortic diameter? J Thorac Dis 2018; 10:S3865-S3866. [PMID: 30631500 DOI: 10.21037/jtd.2018.09.36] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Affiliation(s)
- Kosmas I Paraskevas
- Department of Vascular Surgery, Royal Free Hospital, Royal Free London NHS Foundation Trust, London, UK
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19
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Some asymptomatic abdominal aortic aneurysms smaller than 5.5 cm can be considered for elective repair. J Vasc Surg 2018; 67:1645-1648. [DOI: 10.1016/j.jvs.2018.01.042] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Accepted: 01/17/2018] [Indexed: 11/23/2022]
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20
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Paraskevas KI, Brar R, Constantinou J, Tsui J, Baker DM. Screening Programs for Abdominal Aortic Aneurysms: Luxury or Necessity? Angiology 2018; 70:385-387. [DOI: 10.1177/0003319718766740] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Kosmas I. Paraskevas
- Department of Vascular and Endovascular Surgery, Royal Free Hospital, Royal Free London NHS Foundation Trust, London, United Kingdom
| | - Ranjeet Brar
- Department of Vascular and Endovascular Surgery, Royal Free Hospital, Royal Free London NHS Foundation Trust, London, United Kingdom
| | - Jason Constantinou
- Department of Vascular and Endovascular Surgery, Royal Free Hospital, Royal Free London NHS Foundation Trust, London, United Kingdom
| | - Janice Tsui
- Department of Vascular and Endovascular Surgery, Royal Free Hospital, Royal Free London NHS Foundation Trust, London, United Kingdom
| | - Daryll M. Baker
- Department of Vascular and Endovascular Surgery, Royal Free Hospital, Royal Free London NHS Foundation Trust, London, United Kingdom
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21
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Paraskevas KI. Reconsidering the Rupture Risk Potential of Abdominal Aortic Aneurysms in High Risk Patients. Eur J Vasc Endovasc Surg 2018; 55:290. [PMID: 29292206 DOI: 10.1016/j.ejvs.2017.12.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2017] [Accepted: 12/06/2017] [Indexed: 10/18/2022]
Affiliation(s)
- Kosmas I Paraskevas
- Department of Vascular and Endovascular Surgery, Royal Free Hospital, Royal Free London NHS Foundation Trust, London, UK.
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