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Ogino H, Iida O, Akutsu K, Chiba Y, Hayashi H, Ishibashi-Ueda H, Kaji S, Kato M, Komori K, Matsuda H, Minatoya K, Morisaki H, Ohki T, Saiki Y, Shigematsu K, Shiiya N, Shimizu H, Azuma N, Higami H, Ichihashi S, Iwahashi T, Kamiya K, Katsumata T, Kawaharada N, Kinoshita Y, Matsumoto T, Miyamoto S, Morisaki T, Morota T, Nanto K, Nishibe T, Okada K, Orihashi K, Tazaki J, Toma M, Tsukube T, Uchida K, Ueda T, Usui A, Yamanaka K, Yamauchi H, Yoshioka K, Kimura T, Miyata T, Okita Y, Ono M, Ueda Y. JCS/JSCVS/JATS/JSVS 2020 Guideline on Diagnosis and Treatment of Aortic Aneurysm and Aortic Dissection. Circ J 2023; 87:1410-1621. [PMID: 37661428 DOI: 10.1253/circj.cj-22-0794] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/05/2023]
Affiliation(s)
- Hitoshi Ogino
- Department of Cardiovascular Surgery, Tokyo Medical University
| | - Osamu Iida
- Cardiovascular Center, Kansai Rosai Hospital
| | - Koichi Akutsu
- Cardiovascular Medicine, Nippon Medical School Hospital
| | - Yoshiro Chiba
- Department of Cardiology, Mito Saiseikai General Hospital
| | | | | | - Shuichiro Kaji
- Department of Cardiovascular Medicine, Kansai Electric Power Hospital
| | - Masaaki Kato
- Department of Cardiovascular Surgery, Morinomiya Hospital
| | - Kimihiro Komori
- Division of Vascular and Endovascular Surgery, Department of Surgery, Nagoya University Graduate School of Medicine
| | - Hitoshi Matsuda
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center
| | - Kenji Minatoya
- Department of Cardiovascular Surgery, Graduate School of Medicine, Kyoto University
| | | | - Takao Ohki
- Division of Vascular Surgery, Department of Surgery, The Jikei University School of Medicine
| | - Yoshikatsu Saiki
- Division of Cardiovascular Surgery, Graduate School of Medicine, Tohoku University
| | - Kunihiro Shigematsu
- Department of Vascular Surgery, International University of Health and Welfare Mita Hospital
| | - Norihiko Shiiya
- First Department of Surgery, Hamamatsu University School of Medicine
| | | | - Nobuyoshi Azuma
- Department of Vascular Surgery, Asahikawa Medical University
| | - Hirooki Higami
- Department of Cardiology, Japanese Red Cross Otsu Hospital
| | | | - Toru Iwahashi
- Department of Cardiovascular Surgery, Tokyo Medical University
| | - Kentaro Kamiya
- Department of Cardiovascular Surgery, Tokyo Medical University
| | - Takahiro Katsumata
- Department of Thoracic and Cardiovascular Surgery, Osaka Medical College
| | - Nobuyoshi Kawaharada
- Department of Cardiovascular Surgery, Sapporo Medical University School of Medicine
| | | | - Takuya Matsumoto
- Department of Vascular Surgery, International University of Health and Welfare
| | | | - Takayuki Morisaki
- Department of General Medicine, IMSUT Hospital, the Institute of Medical Science, the University of Tokyo
| | - Tetsuro Morota
- Department of Cardiovascular Surgery, Nippon Medical School Hospital
| | | | - Toshiya Nishibe
- Department of Cardiovascular Surgery, Tokyo Medical University
| | - Kenji Okada
- Department of Surgery, Division of Cardiovascular Surgery, Kobe University Graduate School of Medicine
| | | | - Junichi Tazaki
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University
| | - Masanao Toma
- Department of Cardiology, Hyogo Prefectural Amagasaki General Medical Center
| | - Takuro Tsukube
- Department of Cardiovascular Surgery, Japanese Red Cross Kobe Hospital
| | - Keiji Uchida
- Cardiovascular Center, Yokohama City University Medical Center
| | - Tatsuo Ueda
- Department of Radiology, Nippon Medical School
| | - Akihiko Usui
- Department of Cardiac Surgery, Nagoya University Graduate School of Medicine
| | - Kazuo Yamanaka
- Cardiovascular Center, Nara Prefecture General Medical Center
| | - Haruo Yamauchi
- Department of Cardiac Surgery, The University of Tokyo Hospital
| | | | - Takeshi Kimura
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University
| | | | - Yutaka Okita
- Department of Surgery, Division of Cardiovascular Surgery, Kobe University Graduate School of Medicine
| | - Minoru Ono
- Department of Cardiac Surgery, Graduate School of Medicine, The University of Tokyo
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Early and mid-term results after endovascular repair of non-infected saccular lesions of the infrarenal aorta. Eur J Vasc Endovasc Surg 2022; 63:808-816. [DOI: 10.1016/j.ejvs.2022.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 01/24/2022] [Accepted: 03/05/2022] [Indexed: 11/24/2022]
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Imaging Predictive Factors of Abdominal Aortic Aneurysm Growth. J Clin Med 2021; 10:jcm10091917. [PMID: 33925046 PMCID: PMC8124923 DOI: 10.3390/jcm10091917] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 04/22/2021] [Accepted: 04/23/2021] [Indexed: 01/14/2023] Open
Abstract
Background: Variable imaging methods may add important information about abdominal aortic aneurysm (AAA) progression. The aim of this study is to assess available literature data regarding the predictive imaging factors of AAA growth. Methods: This systematic review was conducted using the PRISMA guidelines. A review of the literature was conducted, using PubMed, EMBASE and CENTRAL databases. The quality of the studies was assessed using the Newcastle-Ottawa Scale. Primary outcomes were defined as AAA growth rate and factors associated to sac expansion. Results: The analysis included 23 studies. All patients (2244; mean age; 69.8 years, males; 85%) underwent imaging with different modalities; the initial evaluation was followed by one or more studies to assess aortic expansion. AAA initial diameter was reported in 13 studies (range 19.9–50.9 mm). Mean follow-up was 34.5 months. AAA diameter at the end was ranging between 20.3 and 55 mm. The initial diameter and intraluminal thrombus were characterized as prognostic factors associated to aneurysm expansion. A negative association between atherosclerosis and AAA expansion was documented. Conclusions: Aneurysm diameter is the most studied factor to be associated with expansion and the main indication for intervention. Appropriate diagnostic modalities may account for different anatomical characteristics and identify aneurysms with rapid growth and higher rupture risk. Future perspectives, including computed mathematical models that will assess wall stress and elasticity and further flow characteristics, may offer valuable alternatives in AAA growth prediction.
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Abstract
PURPOSE OF REVIEW Functional and molecular aortic imaging has shown great promise for evaluation of aortic disease, and may soon augment conventional assessment of aortic dimensions for the clinical management of patients. RECENT FINDINGS A range of imaging techniques is available for evaluation of patients with aortic disease. Magnetic resonance blood flow imaging can identify atherosclerosis prone aortic regions and may be useful for predicting aneurysm growth. Computational modeling can demonstrate significant differences in wall stress between abdominal aortic aneurysms of similar size and may better predict rupture than diameter alone. Metabolic imaging with fluorodeoxyglucose-PET [(FDG)-PET] can identify focal aortic wall inflammation that may portend rapid progression of disease. Molecular imaging with probes that target collagen and elastin can directly exhibit changes in the vessel wall associated with disease. SUMMARY The complexity of aortic disease is more fully revealed with new functional imaging techniques than with conventional anatomic analysis alone. This may better inform surveillance imaging regimens, medical management and decisions regarding early intervention for aortic disease.
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Lai CH, Chang RS, Luo CY, Kan CD, Lin PY, Yang YJ. Mycotic Aneurysms in the Abdominal Aorta and Iliac Arteries: CT-based Grading and Correlation with Surgical Outcomes. World J Surg 2012. [DOI: 10.1007/s00268-012-1850-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
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Humphrey JD, Holzapfel GA. Mechanics, mechanobiology, and modeling of human abdominal aorta and aneurysms. J Biomech 2012; 45:805-14. [PMID: 22189249 PMCID: PMC3294195 DOI: 10.1016/j.jbiomech.2011.11.021] [Citation(s) in RCA: 187] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/10/2011] [Indexed: 12/25/2022]
Abstract
Biomechanical factors play fundamental roles in the natural history of abdominal aortic aneurysms (AAAs) and their responses to treatment. Advances during the past two decades have increased our understanding of the mechanics and biology of the human abdominal aorta and AAAs, yet there remains a pressing need for considerable new data and resulting patient-specific computational models that can better describe the current status of a lesion and better predict the evolution of lesion geometry, composition, and material properties and thereby improve interventional planning. In this paper, we briefly review data on the structure and function of the human abdominal aorta and aneurysmal wall, past models of the mechanics, and recent growth and remodeling models. We conclude by identifying open problems that we hope will motivate studies to improve our computational modeling and thus general understanding of AAAs.
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Affiliation(s)
- J D Humphrey
- Department of Biomedical Engineering and Vascular Biology and Therapeutics Program, Malone Engineering Center, Yale University, New Haven, CT 06520-8260, USA.
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Powell JT, Gotensparre SM, Sweeting MJ, Brown LC, Fowkes FGR, Thompson SG. Rupture rates of small abdominal aortic aneurysms: a systematic review of the literature. Eur J Vasc Endovasc Surg 2010; 41:2-10. [PMID: 20952216 DOI: 10.1016/j.ejvs.2010.09.005] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2010] [Accepted: 09/01/2010] [Indexed: 12/26/2022]
Abstract
BACKGROUND Small aneurysms of the abdominal aorta (3.0-5.5 cm in diameter) often are managed by regular surveillance, rather than surgery, because the risk of surgery is considered to outweigh the risk of aneurysm rupture. The risk of small aneurysm rupture is considered to be low. The purpose of this review is to summarise the reported estimates of small aneurysm rupture rates. METHODS AND FINDINGS We conducted a systematic review of the literature published before 2010 and identified 54 potentially eligible reports. Detailed review of these studies showed that both ascertainment of rupture, patient follow-up and causes of death were poorly reported: diagnostic criteria for rupture were never reported. There were only 14 studies from which rupture rates (as ruptures per 100 person-years) were available. These 14 published studies included 9779 patients (89% male) over the time period 1976-2006 but only 7 of these studies provided rupture rates specifically for the diameter range 3.0-5.5 cm, which ranged from 0 to 1.61 ruptures per 100 person-years. CONCLUSIONS Rupture rates of small abdominal aortic aneurysms would appear to be low, but most studies have been poorly reported and did not have clear ascertainment and diagnostic criteria for aneurysm rupture.
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Affiliation(s)
- J T Powell
- Vascular Surgery Research Group, Imperial College London, Charing Cross Campus, St Dunstan's Road, London W6 8RP, UK.
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8
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Measurement and determinants of infrarenal aortic thrombus volume. Eur Radiol 2008; 18:1987-94. [DOI: 10.1007/s00330-008-0956-3] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2007] [Revised: 01/23/2008] [Accepted: 02/16/2008] [Indexed: 10/22/2022]
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Svensson LG, Kouchoukos NT, Miller DC, Bavaria JE, Coselli JS, Curi MA, Eggebrecht H, Elefteriades JA, Erbel R, Gleason TG, Lytle BW, Mitchell RS, Nienaber CA, Roselli EE, Safi HJ, Shemin RJ, Sicard GA, Sundt TM, Szeto WY, Wheatley GH. Expert Consensus Document on the Treatment of Descending Thoracic Aortic Disease Using Endovascular Stent-Grafts⁎⁎Expert Consensus Document on the Treatment of Descending Thoracic Aortic Disease Using Endovascular Stent-Grafts has been supported by Unrestricted Educational Grants from Cook, Inc and Medtronic, Inc. Ann Thorac Surg 2008; 85:S1-41. [PMID: 18083364 DOI: 10.1016/j.athoracsur.2007.10.099] [Citation(s) in RCA: 553] [Impact Index Per Article: 34.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2007] [Revised: 10/17/2007] [Accepted: 10/18/2007] [Indexed: 01/15/2023]
Affiliation(s)
- Lars G Svensson
- Center for Aortic Surgery and Marfan Syndrome Clinic, Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, Ohio 44195, USA.
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Truijers M, Pol JA, Schultzekool LJ, van Sterkenburg SM, Fillinger MF, Blankensteijn JD. Wall Stress Analysis in Small Asymptomatic, Symptomatic and Ruptured Abdominal Aortic Aneurysms. Eur J Vasc Endovasc Surg 2007; 33:401-7. [PMID: 17137809 DOI: 10.1016/j.ejvs.2006.10.009] [Citation(s) in RCA: 90] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2006] [Accepted: 10/08/2006] [Indexed: 10/23/2022]
Abstract
OBJECTIVES To evaluate the potential of wall stress analysis for the identification of abdominal aortic aneurysm (AAA) at elevated risk of rupture in spite of small diameter. MATERIALS AND METHODS Thirty patients with small AAA, 10 asymptomatic, 10 symptomatic and 10 ruptured, were included. Demographic data and results from physical examinations were recorded in a retrospective fashion. After CT-evaluation and the creation of a patient specific 3D model, wall stress was calculated using the finite element method. RESULTS No differences were observed in diameter between asymptomatic, symptomatic or ruptured aneurysms (5.1+/-0.2 cm vs. 5.1+/-0.2 cm vs. 5.3+/-0.2 cm respectively; p=0.57). Peak aortic wall stress at maximal systolic blood pressure is significantly higher in ruptured than asymptomatic aneurysms (51.7+/-2.4 N/cm(2) vs. 39.7+/-3.3 N/cm(2) respectively; p=0.04). Wall stress analysis at uniform blood pressure, performed to correct for higher blood pressure in the symptomatic and rupture group did not result in significant differences in peak wall stress (asymptomatic 31.7+/-2.3 N/cm(2); symptomatic 30.5+/-1.3 N/cm(2); rupture 36.7+/-4.0 N/cm(2); p=0.26). CONCLUSIONS Wall stress analysis at maximal systolic blood pressure is a promising technique to detect aneurysms at elevated aneurysm rupture risk. Since no significant differences were found at uniform blood pressure, the need for adequate blood pressure control in aneurysm patients is reiterated.
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Affiliation(s)
- M Truijers
- Department of Vascular Surgery, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.
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Raghavan ML, Kratzberg J, Castro de Tolosa EM, Hanaoka MM, Walker P, da Silva ES. Regional distribution of wall thickness and failure properties of human abdominal aortic aneurysm. J Biomech 2005; 39:3010-6. [PMID: 16337949 DOI: 10.1016/j.jbiomech.2005.10.021] [Citation(s) in RCA: 176] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2005] [Accepted: 10/15/2005] [Indexed: 12/23/2022]
Abstract
The regional distribution of wall thickness and failure properties in human abdominal aortic aneurysm (AAA) was explored. Three unruptured and one ruptured AAA were harvested as a whole during necropsy. Thickness was measured at about every 1.5 cm(2) wall surface area for an average of 100 measurement sites per AAA. Multiple longitudinally oriented rectangular specimen strips were cut at various locations from each AAA for a total of 48 strips. The strips were subjected to uniaxial extension until failure. Wall thickness varied regionally and between AAA from as low as 0.23 mm at a rupture site to 4.26 mm at a calcified site (median=1.48 mm). Wall thickness was slightly lower in the posterior and right regions. The failure tension (ultimate) of specimen strips varied regionally and between AAA from 5.5 N/cm close to a blister site in the ruptured AAA to 42.3N/cm at the undilated neck of a 4 cm diameter unruptured AAA (median=14.8 N/cm). Failure stress (ultimate) varied from 33.6 to 235.1N/cm(2) (median=126.6N/cm(2)). There was no perceptible pattern in failure properties along the circumference. Failure tension of specimen strips at or close to blisters was mostly low. The rupture site in the ruptured aneurysm had the lowest recorded wall thickness of 0.23 mm with only slightly higher readings within a 1cm radius. The failure tension of the specimen strip close to the rupture site was low (11.1 N/cm) compared to its neighborhood in the ruptured aneurysm.
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Affiliation(s)
- Madhavan L Raghavan
- Biomedical Engineering, University of Iowa, 1422 Seamans Center, Iowa City, IA 52242, USA.
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Al-Omran M, Verma S, Lindsay TF, Weisel RD, Sternbach Y. Clinical Decision Making for Endovascular Repair of Abdominal Aortic Aneurysm. Circulation 2004; 110:e517-23. [PMID: 15583084 DOI: 10.1161/01.cir.0000148961.44397.c7] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Mohammed Al-Omran
- Division of Vascular Surgery, Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada
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Xenos ES, Stevens SL, Freeman MB, Pacanowski JP, Cassada DC, Goldman MH. Distribution of sac pressure in an experimental aneurysm model after endovascular repair: the effect of endoleak types I and II. J Endovasc Ther 2003; 10:516-23. [PMID: 12932163 DOI: 10.1177/152660280301000317] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE To study in an experimental aneurysm model the differential distribution of strain/pressure (S/P) on the aneurysm wall before and after endograft exclusion and in the presence of individual type I and type II endoleaks. METHODS Two tapered elliptical Gore-Tex patches were sutured to an anterior and posterior longitudinal arteriotomy of an 8-mm Gore-Tex tube graft, thus creating a fusiform aneurysm. Two S/P transducers were placed at the proximal sac adjacent to the proximal neck, 2 at the site of the widest sac diameter, and 2 at the sac adjacent to the distal neck. The aneurysm, which was connected to a pulsatile pump system, was excluded using a 10-mm endograft. Type I and type II endoleaks were created and tested individually. S/P measurements were obtained at systemic systolic pressures (BP) of 80, 110, and 150 mmHg. Thrombosis of the sac contents was induced by injection of thrombin and calcium in the sac. Angiography was used to verify presence or absence of flow in the sac. RESULTS Aneurysm exclusion resulted in significant S/P reductions at all 3 BP levels versus prior to exclusion (p<0.05). Thrombus in the sac did not alter S/P in the excluded sac (p>0.05 for all 3 BP levels). In the presence of a proximal type I endoleak, S/P distribution was not uniform, and S/P at the proximal neck was close to S/P prior to exclusion (p>0.05 no graft versus type I endoleak for all 3 BP levels). This was also true in the presence of thrombus. With a type II endoleak, S/P was more evenly distributed and was not significantly elevated compared to the pressure without an endoleak (p>0.05, graft versus type II endoleak for all 3 BP levels). Thrombus had no effect on intrasac S/P with a type II endoleak. Intrasac S/P was significantly higher in the presence of a type I endoleak compared to a type II endoleak when BP=150 mmHg (p=0.008). CONCLUSIONS Endovascular exclusion of an aneurysm results in uniform S/P reduction in the aneurysm sac. Type I endoleak, but not type II endoleak, results in significantly higher S/P in an area of the sac adjacent to the proximal neck. Thrombus does not result in significantly different S/P distribution in the aneurysm sac.
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Affiliation(s)
- Eleftherios S Xenos
- Division of Vascular Surgery, University of Tennessee Medical Center, Knoxville, Tennessee 37920, USA.
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Xenos ES, Stevens SL, Freeman MB, Pacanowski JP, Cassada DC, Goldman MH. Distribution of Sac Pressure in an Experimental Aneurysm Model After Endovascular Repair:The Effect of Endoleak Types I and II. J Endovasc Ther 2003. [DOI: 10.1583/1545-1550(2003)010<0516:dospia>2.0.co;2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Hans SS, Jareunpoon O, Huang R, Hans B, Bove P, Zelenock GB. Relationship of residual intraluminal to intrathrombotic pressure in a closed aneurysmal sac. J Vasc Surg 2003; 37:949-53. [PMID: 12756338 DOI: 10.1067/mva.2003.256] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
PURPOSE This study was undertaken to determine the relationship of residual intraluminal aneurysmal sac pressure (ILASP) to intrathrombic aneurysm sac pressure (ITASP) and to define the relationship between abdominal aorta aneurysm (AAA) size (anteroposterior or transverse diameter), volume of intraluminal thrombus, and residual ITASP. METHODS We measured ILASP and ITASP after proximal aortic neck and distal iliac clamping by placing angiocatheters into the lumen and thrombus of an excluded aneurysm sac in 41 consecutive patients. Simultaneously, mean blood pressure was recorded and aneurysm sac pressure ratio was calculated. Changes in ILASP and ITASP after clamping of the inferior mesenteric artery were recorded. In addition, correlation between AAA size, volume of intraluminal thrombus in AAA, and residual ITASP was determined. RESULTS Mean ILASP/blood pressure ratio was 0.40 (SD, 0.20). Mean ITASP/blood pressure ratio was 0.37 (SD, 0.23). There was a significant positive correlation of 0.47 between ITASP and ILASP (P =.002). Clamping of the inferior mesenteric artery resulted in markedly decreased ITASP in 2 patients (n = 40) and ILASP in 4 patients (n = 41). Each centimeter increase in AAA size resulted in a 47 mL increase in thrombus volume. CONCLUSION Increased ILASP results in corresponding increase in ITASP, and increased AAA size is associated with increased thrombus volume. However, neither thrombus volume nor AAA size has any relationship to ITASP.
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Brewster DC, Cronenwett JL, Hallett JW, Johnston KW, Krupski WC, Matsumura JS. Guidelines for the treatment of abdominal aortic aneurysms. Report of a subcommittee of the Joint Council of the American Association for Vascular Surgery and Society for Vascular Surgery. J Vasc Surg 2003; 37:1106-17. [PMID: 12756363 DOI: 10.1067/mva.2003.363] [Citation(s) in RCA: 508] [Impact Index Per Article: 24.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Decision-making in regard to elective repair of abdominal aortic aneurysms (AAA) requires careful assessment of factors that influence rupture risk, operative mortality, and life expectancy. Individualized consideration of these factors in each patient is essential, and the role of patient preference is of increasing importance. It is not possible or appropriate to recommend a single threshold diameter for intervention which can be generalized to all patients. Based upon the best available current evidence, 5.5 cm is the best threshold for repair in an "average" patient. However, subsets of younger, good-risk patients or aneurysms at higher rupture risk may be identified in whom repair at smaller sizes is justified. Conversely, delay in repair until larger diameter may be best for older, higher-risk patients, especially if endovascular repair is not possible. Intervention at diameter <5.5 cm appears indicated in women with AAA. If a patient has suitable anatomy, endovascular repair may be considered, and it is most advantageous for older, higher-risk patients or patients with a hostile abdomen or other technical factors that may complicate standard open repair. With endovascular repair, perioperative morbidity and recovery time are clearly reduced; however, there is a higher reintervention rate, increased surveillance burden, and a small but ongoing risk of AAA rupture. There is no justification at present for different indications for endovascular repair, such as earlier treatment of smaller AAA. Until long-term outcome of endoluminal repair is better defined and results of randomized trials available, the choice between endovascular and open repair will continue to rely heavily on patient preference.
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Flora HS, Talei-Faz B, Ansdell L, Chaloner EJ, Sweeny A, Grass A, Adiseshiah M. Aneurysm Wall Stress and Tendency to Rupture Are Features of Physical Wall Properties: An Experimental Study. J Endovasc Ther 2002. [DOI: 10.1583/1545-1550(2002)009<0665:awsatt>2.0.co;2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Flora HS, Talei-Faz B, Ansdell L, Chaloner EJ, Sweeny A, Grass A, Adiseshiah M. Aneurysm wall stress and tendency to rupture are features of physical wall properties: an experimental study. J Endovasc Ther 2002; 9:665-75. [PMID: 12431152 DOI: 10.1177/152660280200900518] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE To use bench top techniques to examine the biophysical phenomena affecting the risk of abdominal aortic aneurysm (AAA) rupture relative to the physical properties of the aneurysm sac. METHODS Three latex AAAs with different wall elasticities were tested in a validated pulsatile flow model (PFM). Strain gauges were wired to each AAA model at the neck, inflection point, and at the maximum diameter. In initial studies, the influence of pressurization and the mechanical properties of AAA wall stress were evaluated. In subsequent studies, the latex AAAs were excluded with a tube graft and retested in the PFM. After creation of either a type I or II endoleak of known size and pressure, the systemic/intrasac pressure and the AAA wall stress were measured. RESULTS Each model had a complex wall-stress pattern comprising radial, longitudinal, and shear components. The peak wall stress at any point, in the presence of systemic pressurization or endoleak pressure, only reached 1% of the failure strength. In an AAA with a reinforced wall, the peak stress was significantly greater. Statistical analysis showed that wall strength contributed more significantly to wall stress than increasing pressurization within the AAA sac. CONCLUSIONS AAA wall mechanics contribute more significantly to peak wall stress than pressure variations within the system. In particular, increased stiffness (analogous to collagen deposition) significantly increased peak wall stress, which was located at the inflection point rather than at the maximum diameter. Techniques to measure the AAA wall mechanics and the rate of deterioration may predict AAA rupture in the untreated state or in the presence of an endoleak following endovascular repair.
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Affiliation(s)
- Harpaul S Flora
- Vascular/Endovascular Unit, University College, London Hospitals NHS Trust, London, England, UK
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Di Martino ES, Guadagni G, Fumero A, Ballerini G, Spirito R, Biglioli P, Redaelli A. Fluid-structure interaction within realistic three-dimensional models of the aneurysmatic aorta as a guidance to assess the risk of rupture of the aneurysm. Med Eng Phys 2001; 23:647-55. [PMID: 11755809 DOI: 10.1016/s1350-4533(01)00093-5] [Citation(s) in RCA: 186] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Abdominal aortic aneurysm (AAA) disease is a degenerating process whose ultimate event is the rupture of the vessel wall. Rupture occurs when the stresses acting on the wall rise above the strength of the AAA wall tissue. The complex mechanical interaction between blood flow and wall dynamics in a three dimensional custom model of a patient AAA was studied by means of computational coupled fluid-structure interaction analysis. Real 3D AAA geometry is obtained from CT scans image processing. The results provide a quantitative local evaluation of the stresses due to local structural and fluid dynamic conditions. The method accounts for the complex geometry of the aneurysm, the presence of a thrombus and the interaction between solid and fluid. A proven clinical efficacy may promote the method as a tool to determine factual aneurysm risk of rupture and aid the surgeon to refer elective surgery patients.
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Affiliation(s)
- E S Di Martino
- Department of Bioengineering, Politecnico of Milano, Milan, Italy
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Hans SS, Jareunpoon O, Huang RR. Pressure measurements in closed aneurysmal sac during abdominal aortic aneurysm resection. J Vasc Surg 2001; 34:519-25. [PMID: 11533606 DOI: 10.1067/mva.2001.117328] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
PURPOSE This study determined the relationship between closed aneurysmal sac pressure (ASP) and mean blood pressure (BP) during open abdominal aortic aneurysm (AAA) resection and evaluated the contribution of inferior mesenteric and lumbar artery blood flow to ASP after proximal and distal clamping. METHODS We measured ASP after proximal and distal clamping by placing an 18-gauge needle connected to a BP transducer into the excluded aneurysmal sac in 25 consecutive patients from April 1999 to August 2000. Simultaneous measurement of the mean systemic BP was also recorded. The ratio of ASP to mean BP in relation to the number of actively bleeding lumbar arteries (N-LA), diameter of the AAA (D-Cm), and volume of the thrombus in the AAA (Vol-TA) were recorded. RESULTS The mean ASP was 43.32 +/- 15.19 mm Hg, with an ASP to mean BP ratio of 0.47 +/- 0.15. The N-LA in the closed aneurysmal sac ranged from 0 to 6 (mean, 3.4 +/- 1.78). The D-Cm as determined by means of computed tomography (CT) scan of the aorta ranged from 5 to 8 cm in its largest anteroposterior/transverse diameter. The average Vol-TA was 6.15 +/- 4.49 mL. Inferior mesenteric artery blood flow contributed to ASP in three patients (12%). There was no correlation between ASP to mean BP ratios and the N-LA (P =.127), D-Cm (P =.882), or Vol-TA (P =.252). CONCLUSION Closed ASP and ASP ratios are highly variable and do not correlate with N-LA, D-Cm, or the Vol-TA.
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Affiliation(s)
- S S Hans
- Department of Surgery, St. John Macomb Hospital, Warren, MI 48093, USA
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21
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Hall AJ, Busse EF, McCarville DJ, Burgess JJ. Aortic wall tension as a predictive factor for abdominal aortic aneurysm rupture: improving the selection of patients for abdominal aortic aneurysm repair. Ann Vasc Surg 2000; 14:152-7. [PMID: 10742430 DOI: 10.1007/s100169910027] [Citation(s) in RCA: 83] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Aortic wall tension was determined in 40 patients to assess its predictive value in abdominal aortic aneurysm (AAA) rupture. A 3-year retrospective analysis of 243 patients with ruptured AAAs and 45 patients with intact AAAs was conducted. The 288 patient sample was limited to the 40 patients with an abdominal CT scan investigation. Aortic wall tension was calculated using blood pressure data and measurements from computerized tomographic (CT) images of 26 patients with intact AAAs and 14 patients with ruptured AAAs in accordance with LaPlace's Law for wall tension: P x R/W, where P = mean arterial pressure (MAP), R = radius of the vessel, and W = wall thickness of the vessel. The wall tension was approximated with the more readily accessible patient parameters of AAA diameter, MAP, height, and weight. This approximation was termed the body mass index (BMI)-pressure approximation for tension (BPAT), which is AAA diameter/BMI x MAP. Data were analyzed using one-sided t-tests, chi-squared tests, and a regression analysis for the relationship between aortic wall tension and the BPAT. AAA wall tension is a significant predictor of pending rupture. BPAT used to approximate the actual tension in the AAA wall is a more sensitive predictor of rupture than aneurysm diameter alone. A prospective study has been initiated to validate these conclusions.
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Affiliation(s)
- A J Hall
- Division of Cardiovascular Surgery, Regina Health District, Regina, Saskatchewan, Canada
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22
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Schurink G, van Baalen J, Visser M, van Bockel J. Thrombus within an aortic aneurysm does not reduce pressure on the aneurysmal wall. J Vasc Surg 2000. [DOI: 10.1067/mva.2000.103693] [Citation(s) in RCA: 117] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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23
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Wilson K, Whyman M, Hoskins P, Lee AJ, Bradbury AW, Fowkes FG, Ruckley CV. The relationship between abdominal aortic aneurysm wall compliance, maximum diameter and growth rate. CARDIOVASCULAR SURGERY (LONDON, ENGLAND) 1999; 7:208-13. [PMID: 10353673 DOI: 10.1016/s0967-2109(98)00041-6] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
AIM Aortic compliance as measured by the pressure-strain elastic modulus (Ep) and stiffness (beta), may allow a more precise estimate of rupture risk. The aim of this study was to determine the relationships between compliance, maximal aneurysm diameter and growth rate. METHODS Sixty abdominal aortic aneurysm patients of median age 73 years, were studied. Growth rate was derived from repeat ultrasound scans obtained over a median period of 21 months (range 6-48). At the end of follow-up, patients underwent measurement of maximum aortic diameter, Ep and beta using the Diamove echo-tracking system. RESULTS Growth rate correlated positively (r = 0.6, P < 0.01) with maximum diameter on entry to the study There was a positive correlation between mean arterial pressure and Ep (r = 0.3, P = 0.03), but not between mean arterial pressure and beta (r = 0.8, P = 0.61). A positive correlation was found between final maximum diameter and Ep (r = 0.22, P = 0.04) but not beta (r = 0.16, P = 0.11). There was no significant relationship between growth rate and Ep or beta. CONCLUSION Large aneurysms tended to be less compliant. Within a population of abdominal aortic aneurysm of similar maximum diameter there was a 10-fold variation in Ep and beta. Compliance and growth rate were not related. If aortic compliance is related to risk of rupture then this predictive information is likely to be largely independent of that currently obtained from size and growth rate.
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Affiliation(s)
- K Wilson
- Vascular Surgery Unit, University of Edinburgh, Royal Infirmary of Edinburgh, UK
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24
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Galland RB, Whiteley MS, Magee TR. The fate of patients undergoing surveillance of small abdominal aortic aneurysms. Eur J Vasc Endovasc Surg 1998; 16:104-9. [PMID: 9728428 DOI: 10.1016/s1078-5884(98)80150-0] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
OBJECTIVES Increasing numbers of patients with small abdominal aortic aneurysms (AAA) are being diagnosed. The aim of this paper is to define the fate of those patients undergoing surveillance of small AAAs. SETTING U.K. district general hospital. METHODS A prospective study has been carried out of all patients undergoing surveillance. At the time of the first consultation the patient was assessed, a Detsky score calculated and the referral source noted. End points of the study were elective repair of the aneurysm, aneurysm rupture or death of the patient. RESULTS Details of 267 patients were analysed. The referral source was general practitioner in 39%, patients with peripheral vascular disease in 32% and department of urology in 21%. None were referred from population screening. The cumulative 5-year risks of rupture, elective repair or non-AAA related deaths were 15%, 26% and 46% for all patients, 4%, 13% and 38% for patients initially presenting with AAA less than 4 cm diameter and 21%, 42% and 54% for patients presenting with an AAA 4-5.5 cm diameter. All but one of 11 patients whose aneurysm ruptured were unfit or had declined elective repair. There were 56 non-AAA related deaths, the majority due to cardiovascular causes. Those patients with low Detsky scores had a 5-year survival of 62%, those with high scores 44%. The age/sex matched survival or a normal population at 5 years in 80%. CONCLUSION Overall the non-AAA related mortality was greater than the risks of rupture or elective repair. It is important to bear in mind the poor prognosis of this group of patients compared with a normal population when considering elective repair of small AAAs.
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Affiliation(s)
- R B Galland
- Department of Surgery, Royal Berkshire Hospital, Reading, U.K
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25
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Wilson K, Bradbury A, Whyman M, Hoskins P, Lee A, Fowkes G, McCollum P, Ruckley CV. Relationship between abdominal aortic aneurysm wall compliance and clinical outcome: a preliminary analysis. Eur J Vasc Endovasc Surg 1998; 15:472-7. [PMID: 9659880 DOI: 10.1016/s1078-5884(98)80105-6] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Aortic compliance, as measured by the pressure-strain elastic modulus (Ep) and stiffness (B), may allow a more precise estimate of abdominal aortic aneurysm rupture risk than size alone. AIM To determine the relationships between AAA compliance, size, growth, and clinical outcome. METHODS One-hundred and twelve patients with initially non-operated AAA (86 men, 26 women, mean age 73 years), recruited from five centres, underwent baseline compliance measurements and were then followed for a median of 7 (range 2-18) months; 85 patients underwent repeated measurements (median 3, range 2-5) 3-6-monthly over a median of 12 (range 3-18 months). RESULTS Seven patients have ruptured and 16 have undergone repair of non-ruptured AAA. AAA that ruptured had significantly lower Ep and B (more compliant). In AAA that ruptured or required repair there was an inverse relationship between diameter and Ep and B. In those undergoing repeated measurements AAA expansion was only associated with a significant increase in Ep and B in non-operated patients. CONCLUSIONS Baseline AAA compliance was significantly related to rupture and the future requirement for operative repair. Failure of compliance to increase with size may be a marker for rapid growth, developmental symptoms and rupture.
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Affiliation(s)
- K Wilson
- Vascular Surgery Unit, University of Edinburgh, Royal Infirmary, U.K
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26
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Ammori BJ, Madan M, Bodenham AR, Gough MJ. A review of the management of abdominal aortic aneurysms in patients following cardiac transplantation. Eur J Vasc Endovasc Surg 1997; 14:185-90. [PMID: 9345237 DOI: 10.1016/s1078-5884(97)80189-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVES To describe the presentation, preoperative assessment and postoperative management of patients presenting with an infrarenal abdominal aortic aneurysm following a previous cardiac transplant. METHODS The case histories of three patients have been examined and a literature review performed. CONCLUSIONS The majority of patients developing aortic aneurysms had undergone cardiac transplantation for ischaemic cardiomyopathy and thus require detailed assessment of cardiac function preoperatively to exclude accelerated coronary artery disease in the graft. Full invasive cardiac monitoring during surgery is mandatory to maintain haemodynamic stability in patients with a dennervated heart and to avoid postoperative renal failure. The higher incidence of pulmonary and wound complications are discussed, together with protocols for maintaining adequate immunosuppression. Finally, data supporting a higher prevalence and more rapid expansion of aortic aneurysms in immunosuppressed patients is considered and evidence-based recommendations made regarding aneurysm screening in these patients.
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Affiliation(s)
- B J Ammori
- Department of Vascular Surgery, General Infirmary at Leeds, U.K
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27
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O'Connor CJ, Starck T, Goldin MD. Saccular outpouchings of an ascending aortic aneurysm: transesophageal echocardiographic appearance. J Am Soc Echocardiogr 1997; 10:745-8. [PMID: 9339426 DOI: 10.1016/s0894-7317(97)70118-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
The differential diagnosis of cavities in the ascending aorta includes pseudoaneurysms, intimal flaps, and abscesses. We describe the transesophageal echocardiographic and pathologic appearance of a fusiform ascending aortic aneurysm that contained atypical outpouchings that were initially confused with an intimal flap. Awareness of this unreported abnormality and its echocardiographic features will avoid the misdiagnosis of more serious aortic pathology such as acute aortic dissection or infective endocarditis.
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Affiliation(s)
- C J O'Connor
- Rush-Presbyterian/St. Luke's Medical Center, Chicago, IL 60612-3864, USA
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28
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Elger DF, Blackketter DM, Budwig RS, Johansen KH. The influence of shape on the stresses in model abdominal aortic aneurysms. J Biomech Eng 1996; 118:326-32. [PMID: 8872254 DOI: 10.1115/1.2796014] [Citation(s) in RCA: 91] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Presence of a small abdominal aortic aneurysm (AAA) often presents a difficult clinical dilemma--a reparative operation with its inherent risks versus monitoring the growth of the aneurysm, with the accompanying risk of rupture. The risk of rupture is conventionally believed to be a function of the AAA bulge diameter. In this work, we hypothesized that the risk of rupture depends on AAA shape. Because rupture is inevitably linked to stress, membrane theory was used to predict the stresses in the walls of an idealized AAA, using a model which was axisymmetric and fusiform, with the ends merged into straight opened-ended tubes. When the stresses for many different shapes of model AAAs were examined, a number of conclusions became evident: (i) maximum hoop stress typically exceeded maximum meridional stress by a factor of 2 to 3 (ii) the shape of an AAA had a small effect on the meridional stresses and a rather dramatic effect on the hoop stresses, (iii) maximum stress typically occurred near the inflection point of a curve drawn coincident with the AAA wall, and (iv) the maximum stress was a function--not of the bulge diameter---but of the curvatures (i.e. shape) of the AAA wall. This last result suggested that rupture probability should be based on wall curvatures, not on AAA bulge diameter. Because curvatures are not much harder to measure than bulge diameter, this concept may be useful in a clinical setting in order to improve prediction of the likelihood of AAA rupture.
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Affiliation(s)
- D F Elger
- Mechanical Engineering Dept., University of Idaho, Moscow 83844-0902, USA
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29
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Hunter GC, Smyth SH, Aguirre ML, Baxter BT, Bull DA, King DD, Wang YP, Hall KA, Putnam CW. Incidence and histologic characteristics of blebs in patients with abdominal aortic aneurysms. J Vasc Surg 1996; 24:93-101. [PMID: 8691533 DOI: 10.1016/s0741-5214(96)70149-0] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
PURPOSE Aortic blebs-focal outpouchings within aortic aneurysms-may contribute to their eventual rupture. In this study we determine the incidence of aortic blebs and describe their microscopic features. METHODS Computed tomographic scans of the abdominal aorta were obtained in 188 patients with aortic diameters measuring > or = 3 cm and were independently evaluated by a radiologist. The number and location of blebs were recorded, and each was measured with calipers. Sixteen blebs, with an adjacent uninvolved aneurysmal segment of aorta, and tissue from two patients with ruptured aneurysms were examined by light microscopy and immunohistochemical analysis. Specimens from six blebs and five aneurysms were examined for alpha 1 (I) procollagen messenger RNA by in situ hybridization. RESULTS Twenty blebs, ranging in size from 5 to 30 mm (mean, 12 +/- 7 mm), were detected in 11% (20 of 188) of computed tomographic scans. Blebs were observed in 10% (11 of 111) of patients with aortic diameters between 3.0 and 4.9 cm, 10% (6 of 61) of patients with aneurysms between 5.0 and 6.9 cm, and 19% (3 of 16) of patients with aortic diameters > or = 7 cm. Histologically, the major difference between the aneurysmal aortic wall and blebs was found in the media. In aneurysmal aortas, the media consisted of multiple layers of fragmented elastic lamellae, whereas the number of elastic tissue elements along the circumference of the blebs progressively decreased; only a few isolated fragments of elastic tissue were present at the apices. Histologic evidence of rupture was evident in two specimens. A chronic inflammatory cell infiltrate composed of T and B lymphocytes, plasma cells, and macrophages, common to both the aneurysmal and the blebs, was most prominent in the adventitia of aneurysmal tissue, but involved both the media and adventitia of the blebs. In situ hybridization demonstrated the presence of alpha 1 (I) procollagen messenger RNA in four of the five aneurysm segments that were evaluated, compared with only one of six blebs. CONCLUSIONS Blebs were discovered in aneurysms of all sizes; their frequency appeared to be unrelated to aneurysm size. The presence of inflammatory cell infiltrates and absence of alpha 1 (I) procollagen messenger RNA in five of six blebs suggest that a local imbalance of matrix degradation and repair plays a role in the cause of these lesions. Attenuation of the aortic wall accompanying the formation of blebs may predispose these sites to rupture.
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Affiliation(s)
- G C Hunter
- Department of Surgery, University of Arizona Health Sciences Center, Tucson 85724, USA
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30
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Faggioli GL, Freyrie A, Stella A, Pedrini L, Gargiulo M, Tarantini S, Ricotta JJ, D'Addato M. Extracranial internal carotid artery aneurysms: results of a surgical series with long-term follow-up. J Vasc Surg 1996; 23:587-94; discussion 594-5. [PMID: 8627893 DOI: 10.1016/s0741-5214(96)80037-1] [Citation(s) in RCA: 81] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
PURPOSE The purpose of this study was to analyze mode of presentation, surgical treatment, and early and long-term results of a series of extracranial internal carotid artery aneurysms (EICAA). METHODS A retrospective analysis was performed on all cases treated for EICAA in a single institution from March 1974 to March 1995. Patient follow-up was obtained by a surveillance protocol, with duplex scanning performed 3 months after surgery and yearly thereafter. RESULTS Twenty-four EICAA in 20 patients were treated over a 21-year period. The cause was fibromuscular dysplasia in 12 cases (50%), nonspecific "atherosclerosis" in nine (37.5%), previous carotid artery surgery in two (8.3%), and trauma in one case (4.1%). Neurologic symptoms were present in a total of nine cases (37.5%) and were hemispheric in seven (29.1%) and nonhemispheric in two (8.3%). Operative techniques were performed with patients receiving general anesthetic and included aneurysm excision with internal carotid artery reanastomosis (8 cases [33.3%]) or reimplantation onto the external carotid artery (1 case [4.1%]); interposition graft (10 cases [41.6%]), 7 veins, 3 polytetrafluoroethylene) or simple aneurysmectomy and closure of the wall defect either with (3 cases [12.5%]) or without (2 cases [8.3%]) a patch. Elective surgery was performed in 22 cases, with a 0% mortality rate and 4.5% stroke rate. Emergency operations were performed in two cases of ruptured aneurysms (one spontaneous and one iatrogenic); one patient (50%) died. Cranial nerve morbidity occurred in five cases (20.8%). Mean follow-up was 96.7 +/- 88.15 months (range 4 to 240 months) and included 2 of 7 (28%) complications in saphenous vein grafts, 1 (4.1%) late transient ischemic attack, and a recurrent aneurysm after 19 years. CONCLUSIONS Symptoms and potential complications caused by EICAA suggest a broad surgical indication. EICAA can be treated safely because of the good early and long-term results.
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Affiliation(s)
- G L Faggioli
- Department of Vascular Surgery, University of Bologna, Italy
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31
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Hak E, Balm R, Eikelboom BC, Akkersdijk GJ, van der Graaf Y. Abdominal aortic aneurysm screening: an epidemiological point of view. Eur J Vasc Endovasc Surg 1996; 11:270-8. [PMID: 8601237 DOI: 10.1016/s1078-5884(96)80073-6] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Affiliation(s)
- E Hak
- Department of Surgery, University Hospital Utrecht, The Netherlands
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