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Rodríguez Donoso J, Martín Ramos E, Aparicio Velasco J, Fonte Eliozondo L, Muñoz Críspulo E, Ruiz Arribas C. [Abdominal aortic aneurysm ultrasound screening in men with risk factors in Primary Care]. Aten Primaria 2022; 54:102234. [PMID: 34920344 PMCID: PMC8685991 DOI: 10.1016/j.aprim.2021.102234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 08/15/2021] [Accepted: 08/16/2021] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVE to describe the implantation of ultrasound screening for Abdominal Aortic Aneurysm (AAA) in our healthcare district in men from 65 to 79 years of age who have had an identifiable risk factor for developing AAA, such as smoking or a history thereof, hypertension, family history of aneurysms, aneurysms in other locations and clinical atherosclerosis, acute myocardial infarction, intermittent claudication, or stroke. Analyse the performance of said screening. SETTING Primary Care. PARTICIPANTS AND INTERVENTIONS 656 patients were screened, representing 40% of the target population of 1,658 patients. The remaining part of the target population could not be screened because of the outbreak of the COVID-19 pandemic. 608 ultrasound examinations were performed. MAIN MEASUREMENTS coverage of the screening programme, prevalence of abdominal aortic aneurysms, prevalence of smoking and other risk factors in patients with/without aneurysms. RESULTS 19 patients with ectatic aorta (25-29mm) and 11 with abdominal aortic aneurysms (1.81%) were found. 5 were active smokers (45%, compared to 20% in the entire sample) and 6 were former smokers. None of the aneurysm patients were non-smokers. 7 of them were hypertensive. CONCLUSIONS The prevalence of aneurysms in our sample was 2.6%, which was lower than expected. The wide use of ultrasound and its progressive generalisation in the Primary Care setting should lead to a decrease in the number of undiagnosed AAA.
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Iscan HZ, Unal EU, Akkaya B, Daglı M, Karahan M, Civelek I, Ozbek MH, Okten RS. Color Doppler ultrasound for surveillance following EVAR as the primary tool. J Card Surg 2020; 36:111-117. [PMID: 33225510 DOI: 10.1111/jocs.15194] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2020] [Accepted: 10/20/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVE As aneurysm-related events and rupture is not eliminated, postoperative lifelong surveillance is mandatory after endovascular aneurysm repair (EVAR). For surveillance colored Doppler ultrasound (CDUS) is a standard method of noninvasive evaluation having the advantages of availability, cost-effectiveness, and lack of nephrotoxicity and radiation. We evaluated CDUS for primary surveillance tool after elective EVAR by comparing with computerized tomography. METHODS Between January 2018 and March 2020, 84 consecutive post-EVAR patients were evaluated. First, CDUS was performed by two Doppler operators from the Radiology Department and then computed tomographic angiography (CTA) was performed. The operators were blind to CTA reports. A reporting protocol was organized for endoleak detection and largest aneurysm diameter. RESULTS Among 84 patients, there were 11 detected endoleaks (13.1%) with CTA and seven of them was detected with CDUS (r = .884, p < .001). All Type I and III endoleaks were detected perfectly. There is an insufficiency in detecting low flow by CDUS. Eliminating this frailty, there was a strong correlation of aneurysm sac diameter measurement between CTA and CDUS (r = .777, p < .001). The sensitivity and specificity of CDUS was 63.6% and 100%, respectively. The accuracy was 95.2%. Positive and negative predictive values were 100% and 94.8%. Bland-Altman analysis and linear regression analysis showed no proportional bias (mean difference of 1.5 ± 2.2 mm, p = .233). CONCLUSIONS For surveillance, CDUS promises accurate results without missing any potential complication requiring intervention as Type I or III endoleak. Lack of detecting Type II endoleaks may be negligible as sac enlargement was the key for reintervention in this situation and CDUS has a remarkably high correlation with CTA in sac diameter measurement. CDUS may be a primary surveillance tool for EVAR and CTA will be reserved in case of aneurysm sac enlargement, detection of an endoleak, inadequate CDUS, or in case of unexplained abdominal symptomatology. By this way we not only avoid ionizing radiation and nephrotoxic agents, but also achieve cost saving issue also.
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Affiliation(s)
- Hakkı Z Iscan
- Department of Cardiovascular Surgery, Yuksek Ihtisas Cardiovascular Hospital, Ankara City Hospital Complex, Ankara, Turkey
| | - Ertekin U Unal
- Department of Cardiovascular Surgery, Yuksek Ihtisas Cardiovascular Hospital, Ankara City Hospital Complex, Ankara, Turkey
| | - Boğaçhan Akkaya
- Department of Cardiovascular Surgery, Yuksek Ihtisas Cardiovascular Hospital, Ankara City Hospital Complex, Ankara, Turkey
| | - Mustafa Daglı
- Department of Cardiovascular Surgery, Yuksek Ihtisas Cardiovascular Hospital, Ankara City Hospital Complex, Ankara, Turkey
| | - Mehmet Karahan
- Department of Cardiovascular Surgery, Yuksek Ihtisas Cardiovascular Hospital, Ankara City Hospital Complex, Ankara, Turkey
| | - Isa Civelek
- Department of Cardiovascular Surgery, Yuksek Ihtisas Cardiovascular Hospital, Ankara City Hospital Complex, Ankara, Turkey
| | - Mehmet H Ozbek
- Department of Cardiovascular Surgery, Yuksek Ihtisas Cardiovascular Hospital, Ankara City Hospital Complex, Ankara, Turkey
| | - Rıza S Okten
- Department of Radiology, Ankara City Hospital Complex, Ankara, Turkey
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Abstract
Ultrasound (US) and Doppler are often the first imaging to be carried out for arterial disease, and with good reason. US is noninvasive, free of radiation exposure and crucial for follow up imaging. The review that follows aims to highlight the various applications of US in imaging of the arterial system.
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Affiliation(s)
- Prashant Gupta
- Department of Radiology, Scunthorpe General Hospital, Northern Lincolnshire and Goole NHS Foundation Trust, UK
| | - Shannon Lyons
- Division of Cardiovascular Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Sandeep Hedgire
- Division of Cardiovascular Imaging, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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Ascoli Marchetti A, Pratesi G, Di Giulio L, Battistini M, Massoud R, Ippoliti A. EVAR and OPEN treatment of abdominal aortic aneurysm: What is the role of MMP-9 in the follow-up? JOURNAL DE MÉDECINE VASCULAIRE 2017; 42:21-28. [PMID: 28705444 DOI: 10.1016/j.jdmv.2017.01.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Accepted: 12/11/2016] [Indexed: 12/13/2022]
Abstract
INTRODUCTION The aim of our study is to verify the role of metalloproteinases in endovascular repair (EVAR) and OPEN surgery treatment for abdominal aortic aneurysm (AAA). Postoperatively, these enzymes could represent an important biomarker to adapt diagnostic tests and further investigations during follow-up. MATERIAL AND METHOD From 2004 to 2008, 55 patients were considered with AAA. Of these, 33 patients (mean age: 70.1 years), (mean AAA diameter: 5.4cm) were treated with OPEN surgery (group A) and 22 (mean age: 74.1 years) (mean AAA diameter: 5.1cm) were treated with EVAR. In 17 of them, there were no signs of endoleak (group B1), while in 5 patients, a presence of endoleak (group B2) was detected. Plasma samples were collected in order to determine MMP-9 activity. Enzyme immunoassay was performed preoperatively at 1, 3, 6 and 12 months. Patients treated conventionally were clinically examined after 1 and 12 months by ultrasound. Patients undergoing EVAR treatment were clinically examined by CT scan after 1, 3, 6 and 12 months. The analysis was done by assessing the interaction over time of the MMP-9 value in B1 and B2 groups. RESULTS The average values observed for MMP-9 were preoperatively and at 1, 3, 6 and 12 months, respectively: in group A 150.8ng/mL (SD=30.5), 252.5ng/mL (SD=25.2), 315.4ng/mL (SD=22.7), 295.3ng/mL (SD=26.8), 210.7ng/mL (SD=30.2); in group B1 105ng/mL (SD=10.8), 125.6ng/mL (SD=18), 85.8ng/mL (SD=19.9), 95ng/mL (SD=20.2), 80.4ng/mL (SD=15.6); in group B2 149ng/mL (29.2), 375.4ng/mL (SD=40.2), 215ng/mL (SD=35.9), 180ng/mL (SD=20.2), 175ng/mL (SD=33.4). The MMP-9 level was higher in group B2 compared to group B1 (P=0.01), suggesting a correlation with the presence of the endoleak. CONCLUSIONS This preliminary study shows that MMP-9 may be a biomarker of the presence of endoleak. Other further investigations and larger series are needed to show that metalloproteases could play a role in the follow-up of EVAR treated patients.
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Affiliation(s)
- A Ascoli Marchetti
- Vascular Surgery, Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy.
| | - G Pratesi
- Vascular Surgery, Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - L Di Giulio
- Vascular Surgery, Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - M Battistini
- Vascular Surgery, Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - R Massoud
- Department of Experimental Medicine and Surgery, University of Rome Tor Vergata, Rome, Italy
| | - A Ippoliti
- Vascular Surgery, Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
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Chuter TA, Parodi JC, Lawrence-Brown M. Management of Abdominal Aortic Aneurysm: A Decade of Progress. J Endovasc Ther 2016. [DOI: 10.1177/15266028040110s611] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Since the world was first introduced to the concept of endovascular aneurysm repair by Parodi's landmark procedures in 1990, stent-grafts have assumed a prominent role in the management of abdominal aortic aneurysm. Most modern systems are trackable, accurate, and secure. The resulting endovascular procedure is safe, durable, effective, and versatile. Perhaps the most significant increment in the applicability of the endovascular technique was achieved by the development of bifurcated stent-grafts, which dispensed with inadequate distal aortic implantation sites. Additional branches and fenestrations now permit endovascular repair in cases of thoracoabdominal, pararenal, juxtarenal, and bilateral iliac aneurysms. These advances in device performance have been accompanied by a rapid dissemination of necessary skills, leading to the development of a new superspecialty of vascular therapy, with elements of vascular surgery, interventional radiology, and interventional cardiology.
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Affiliation(s)
| | - Juan C. Parodi
- Washington University School of Medicine, St. Louis, Missouri, USA
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Dindyal S, Kyriakides C. Duplex ultrasound with the implementation of contrast enhancement in selected cases is satisfactory for EVAR surveillance. J Endovasc Ther 2012; 19:844-6; author reply 846. [PMID: 23210887 DOI: 10.1583/jevt-12-4060l.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Gray C, Goodman P, Herron CC, Lawler LP, O'Malley MK, O'Donohoe MK, McDonnell CO. Use of colour duplex ultrasound as a first line surveillance tool following EVAR is associated with a reduction in cost without compromising accuracy. Eur J Vasc Endovasc Surg 2012; 44:145-50. [PMID: 22717670 DOI: 10.1016/j.ejvs.2012.05.008] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2011] [Accepted: 05/06/2012] [Indexed: 11/17/2022]
Abstract
INTRODUCTION CT scanning remains the postoperative surveillance imaging modality of choice following EVAR. Concerns regarding cost, exposure to ionising radiation and intravenous contrast have led to a search for a less expensive, equally efficacious and safer method of monitoring EVAR patients after endograft deployment. This study evaluated the cost saving obtained if CDUS was employed as a first line surveillance tool following EVAR, as well as comparing the two entities in terms of efficacy. PATIENTS & METHODS Postoperative surveillance CTs and CDUS scans in the 145 patients who have undergone EVAR from 1st June 2003 to 1st July 2010 were compared for the detection of endoleak and determination of residual sac size. RESULTS Adopting a protocol where CDUS was employed as the first line surveillance tool following EVAR would result in a reduction in the number of postoperative CTs required in 2010 from 235 to 36. Based on 2010 costings, this would equate to an estimated reduction in expenditure from €117,500 to €34,915 a saving of €82,585. CDUS had a sensitivity of 100% and a specificity of 85% in the detection of endoleaks compared to CT. The positive predictive value was 28% and negative predictive value 100%. The Pearson Coefficient correlation of 0.96 indicates a large degree of correlation between CDUS and CT when measuring residual aneurysm size following EVAR. CONCLUSION CDUS can replace CT as the first line surveillance tool following EVAR. This is associated with a significant reduction in the cost of surveillance without any loss of imaging accuracy.
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Affiliation(s)
- C Gray
- Department of Vascular Surgery, Mater Misericordiae University Hospital, Dublin 7, Ireland
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Venermo MA, Arko FR, Salenius JP, Saarinen JP, Zvaigzne A, Zarins CK. EVAR May Reduce the Risk of Aneurysm Rupture Despite Persisting Type Ia Endoleaks. J Endovasc Ther 2011; 18:676-82. [PMID: 21992639 DOI: 10.1583/11-3432.1] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
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Surveillance des endoprothèses aortiques abdominales : intérêt de l’échographie-doppler standard et avec contraste. ACTA ACUST UNITED AC 2009; 34:34-43. [DOI: 10.1016/j.jmv.2008.10.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2008] [Accepted: 10/08/2008] [Indexed: 11/17/2022]
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Collins JT, Boros MJ, Combs K. Ultrasound surveillance of endovascular aneurysm repair: a safe modality versus computed tomography. Ann Vasc Surg 2008; 21:671-5. [PMID: 17980791 DOI: 10.1016/j.avsg.2007.07.009] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2007] [Revised: 04/16/2007] [Accepted: 07/16/2007] [Indexed: 11/19/2022]
Abstract
Routine ultrasound surveillance is adequate and safe for monitoring endovascular aneurysm repairs (EVARs). A retrospective chart review including 160 endograft patients was performed from August 2000 to September 2005. All ultrasound examinations (n = 359) were performed by a board-certified vascular surgery group's accredited laboratory. Registered vascular technologists utilized the same equipment consisting of Siemens Antares high-definition ultrasonography with tissue harmonics and color flow Doppler. An identical protocol was followed by each technologist: scan body and both limbs of the endograft and distal iliac vessels, measure anterior-posterior aneurysm sac size, and detect intrasac pulsatility and color flow. Statistical analysis utilized Pearson's correlation coefficient and the paired t-test. Forty-one endoleaks were discovered out of the 359 exams (11.4%). There were type I (7, 17%), type II (26, 63%), and combined type I with type II (8, 20%) endoleaks. Correlation with computed tomography (CT) was obtained in 35 of these cases. CT discovered three endoleaks that were not seen with ultrasound. However, these particular ultrasound exams were inadequate due to additional factors (bowel gas, body habitus, hernia), which prompted CT investigation and, hence, endoleak discovery. Of the 41 endoleaks found on ultrasound, only 14 were seen on CT. Specifically, 26 type II endoleaks were seen with ultrasound versus only nine during CT. Additional factors addressed included comparison between ultrasound and CT of residual aneurysm sac measurements and conditions limiting ultrasound examination. Although criticized in the past, color flow ultrasonography is a safe and effective modality for surveillance of aortic endografts. Utilizing ultrasound to analyze abdominal aortic aneurysm (AAA) sac dimensions and endoleak detection is statistically sound for screening AAA status post-EVAR.
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Affiliation(s)
- John T Collins
- Department of Surgery, Kalamazoo Center for Medical Studies, Michigan State University, Kalamazoo, MI 49008, USA
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Riambau V, Guerrero F, Montañá X, Gilabert R. [Abdominal aortic aneurysm and renovascular disease]. Rev Esp Cardiol 2007; 60:639-54. [PMID: 17580053 DOI: 10.1157/13107121] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Recent technological advances in the diagnosis and therapy of abdominal aortic aneurysm and renovascular disease are continuing to bring about changes in the way patients suffering from these conditions are treated. The prevalence of both these conditions is increasing. This is due to greater life-expectancy in patients with arteriosclerosis, a pathogenetic factor underlying both conditions. The application of diagnostic imaging techniques to non-vascular conditions has led to the early diagnosis of abdominal aortic aneurysm. Clinical suspicion of reno-vascular disease can be confirmed easily using high-resolution diagnostic imaging modalities such as CT angiography and magnetic resonance angiography. Endovascular intervention is successfully replacing conventional surgical repair techniques, with the result that it may be possible to improve outcome in both conditions using effective and minimally invasive approaches. Future technological developments will enable these endovascular techniques to be applied in the large majority of patients with abdominal aortic aneurysm or renovascular disease.
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Affiliation(s)
- Vicente Riambau
- Cirugía vascular, Instituto del Tórax, Hospital Clínic, Barcelona, Spain
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Abstract
Contrast-induced nephropathy (CIN) is a well-recognized complication of radiographic contrast administration and is the third leading cause of hospital-acquired renal insufficiency. The use of contrast media is increasing, particularly in the area of endovascular therapy. Vascular interventionists need to be aware of strategies to reduce the risk of CIN. Numerous trials, meta-analyses, and expert guidelines for the prevention of CIN have been published between 1966 and 2006, but the majority of studies have been conducted on patients undergoing coronary interventions; few have involved vascular surgical population. The literature suggests that adequate hydration is essential in all patients due to receive contrast. No pharmacological agents have been shown to conclusively reduce the risk. Forced diuresis is harmful, and there is insufficient evidence to support routine use of hemodialysis or hemofiltration. Well conducted studies of other potential prophylactic techniques are needed in vascular populations.
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Affiliation(s)
- Stewart R Walsh
- Cambridge Vascular Research Unit, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
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Chuter TAM, Parodi JC, Lawrence-Brown M. Management of Abdominal Aortic Aneurysm: A Decade of Progress. J Endovasc Ther 2004. [DOI: 10.1583/04-1388.1] [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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