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Tachibana Y, Takaji R, Shiroo T, Asayama Y. Deep-learning reconstruction with low-contrast media and low-kilovoltage peak for CT of the liver. Clin Radiol 2024; 79:e546-e553. [PMID: 38238148 DOI: 10.1016/j.crad.2023.12.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 12/13/2023] [Accepted: 12/19/2023] [Indexed: 03/09/2024]
Abstract
AIM To compare images using reduced CM, low-kVp scanning and DLR reconstruction with conventional images (no CM reduction, normal tube voltage, reconstructed with HBIR. To compare images using reduced contrast media (CM), low kilovoltage peak (kVp) scanning and deep-learning reconstruction (DLR) with conventional image quality (no CM reduction, normal tube voltage, reconstructed with hybrid-type iterative reconstruction method [HBIR protocol]). MATERIALS AND METHODS A retrospective analysis was performed on 70 patients with liver disease and three-phase dynamic imaging using computed tomography (CT) from April 2020 to March 2022 at Oita University Hospital. Of these cases, 39 were reconstructed using the DLR protocol at a tube voltage of 80 kVp and CM of 300 mg iodine/kg while 31 were imaged at a tube voltage of 120 kVp with CM of 600 mg iodine/kg and were reconstructed by the usual HBIR protocol. Images from the DLR and HBIR protocols were analysed and compared based on the contrast-to-noise ratio (CNR), signal-to-noise ratio (SNR), figure-of-merit (FOM), and visual assessment. The CT dose index (CTDI)vol and size-specific dose estimates (SSDE) were compared with respect to radiation dose. RESULTS The DLR protocol was superior, with significant differences in CNR, SNR, and FOM except hepatic parenchyma in the arterial phase. For visual assessment, the DLR protocol had better values for vascular visualisation for the portal vein, image noise, and contrast enhancement of the hepatic parenchyma. Regarding comparison of the radiation dose, the DLR protocol was superior for all values of CTDIvol and SSDE, with significant differences (p<0.01; max. 52%). CONCLUSION Protocols using DLR with reduced CM and low kVp have better image quality and lower radiation dose compared to protocols using conventional HBIR.
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Affiliation(s)
- Y Tachibana
- Graduate School of Medicine, Oita University, 1-1 Idaigaoka, Hasama-machi, Yufu, 879-5593, Japan
| | - R Takaji
- Department of Radiology, Oita University Faculty of Medicine, 1-1 Idaigaoka, Hasama-machi, Yufu, 879-5593, Japan
| | - T Shiroo
- Radiology Department, Division of Medical Technology, Oita University Hospital, 1-1 Idaigaoka, Hasama-machi, Yufu, 879-5593, Japan
| | - Y Asayama
- Department of Radiology, Oita University Faculty of Medicine, 1-1 Idaigaoka, Hasama-machi, Yufu, 879-5593, Japan.
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Black SM, Maclean C, Barrientos PH, Ritos K, Kazakidi A. Reconstruction and Validation of Arterial Geometries for Computational Fluid Dynamics Using Multiple Temporal Frames of 4D Flow-MRI Magnitude Images. Cardiovasc Eng Technol 2023; 14:655-676. [PMID: 37653353 PMCID: PMC10602980 DOI: 10.1007/s13239-023-00679-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 08/08/2023] [Indexed: 09/02/2023]
Abstract
PURPOSE Segmentation and reconstruction of arterial blood vessels is a fundamental step in the translation of computational fluid dynamics (CFD) to the clinical practice. Four-dimensional flow magnetic resonance imaging (4D Flow-MRI) can provide detailed information of blood flow but processing this information to elucidate the underlying anatomical structures is challenging. In this study, we present a novel approach to create high-contrast anatomical images from retrospective 4D Flow-MRI data. METHODS For healthy and clinical cases, the 3D instantaneous velocities at multiple cardiac time steps were superimposed directly onto the 4D Flow-MRI magnitude images and combined into a single composite frame. This new Composite Phase-Contrast Magnetic Resonance Angiogram (CPC-MRA) resulted in enhanced and uniform contrast within the lumen. These images were subsequently segmented and reconstructed to generate 3D arterial models for CFD. Using the time-dependent, 3D incompressible Reynolds-averaged Navier-Stokes equations, the transient aortic haemodynamics was computed within a rigid wall model of patient geometries. RESULTS Validation of these models against the gold standard CT-based approach showed no statistically significant inter-modality difference regarding vessel radius or curvature (p > 0.05), and a similar Dice Similarity Coefficient and Hausdorff Distance. CFD-derived near-wall hemodynamics indicated a significant inter-modality difference (p > 0.05), though these absolute errors were small. When compared to the in vivo data, CFD-derived velocities were qualitatively similar. CONCLUSION This proof-of-concept study demonstrated that functional 4D Flow-MRI information can be utilized to retrospectively generate anatomical information for CFD models in the absence of standard imaging datasets and intravenous contrast.
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Affiliation(s)
| | - Craig Maclean
- Research and Development, Terumo Aortic, Glasgow, UK
| | - Pauline Hall Barrientos
- Clinical Physics, Queen Elizabeth University Hospital, NHS Greater Glasgow & Clyde, Glasgow, UK
| | - Konstantinos Ritos
- Department of Mechanical and Aerospace Engineering, Glasgow, UK
- Department of Mechanical Engineering, University of Thessaly, Volos, Greece
| | - Asimina Kazakidi
- Department of Biomedical Engineering, University of Strathclyde, Glasgow, UK.
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Jalili MH, Yu T, Hassani C, Prosper AE, Finn JP, Bedayat A. Contrast-enhanced MR Angiography without Gadolinium-based Contrast Material: Clinical Applications Using Ferumoxytol. Radiol Cardiothorac Imaging 2022; 4:e210323. [PMID: 36059381 PMCID: PMC9434982 DOI: 10.1148/ryct.210323] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Revised: 07/01/2022] [Accepted: 07/15/2022] [Indexed: 04/25/2023]
Abstract
Vascular imaging can be challenging because of the wide variability of contrast dynamics in different vascular territories and potential safety concerns in patients with renal insufficiency or allergies. Off-label diagnostic use of ferumoxytol, a superparamagnetic iron nanoparticle approved for therapy, is a promising alternative to gadolinium-based contrast agents for MR angiography (MRA). Ferumoxytol has exhibited a reassuring safety profile when used within the dose range recommended for diagnostic imaging. Because of its prolonged and stable intravascular residence, ferumoxytol can be used in its steady-state distribution for a wide variety of imaging indications, including some where conventional MRA is unreliable. In this article, authors discuss some of the major vascular applications of ferumoxytol and highlight how it may be used to provide highly diagnostic images and improve the quality, workflow, and reliability of vascular imaging. Keywords: MR Angiography, MRI Contrast Agent, Cardiac, Vascular © RSNA, 2022.
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Noda Y, Nakamura F, Kawai N, Suzuki R, Miyoshi T, Ishihara T, Hyodo F, Kambadakone AR, Matsuo M. Optimized Bolus Threshold for Dual-Energy CT Angiography with Monoenergetic Images: A Randomized Clinical Trial. Radiology 2021; 300:615-623. [PMID: 34128721 DOI: 10.1148/radiol.2021210102] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Background The bolus-tracking technique from single-energy CT has been applied to dual-energy CT (DECT) without optimization or validation. Further optimization is imperative because of a paucity of literature and differences in the attenuation profile of virtual monoenergetic images (VMIs). Purpose To determine the optimal trigger threshold with bolus-tracking technique for DECT angiography (DECTA) in a phantom study and assess the feasibility of an optimized threshold for bolus-tracking technique in DECTA at 40 keV with a 50% reduced iodine dose in human participants. Materials and Methods A phantom study with rapid kilovoltage-switching DECT was performed to determine the optimal threshold for each kiloelectron-volt VMI. In a prospective study, consecutive participants who underwent whole-body CT angiography (CTA) from August 2018 to July 2019 were randomized into three groups: single-energy CTA (SECTA) with standard iodine dose (600 mg of iodine per kilogram), DECTA with 50% reduced iodine dose (300 mg of iodine per kilogram) by using a conventional threshold, and DECTA with 300 mg of iodine per kilogram by using an optimized threshold. A trigger threshold of 100 HU at 120 kVp was used as a reference for comparison. Injected iodine doses and aortic CT numbers were compared among the three groups using Kruskal-Wallis test. Results Ninety-six participants (mean age ± standard deviation, 72 years ± 9; 80 men) were evaluated (32 participants in each group). The optimized threshold for VMIs at 40 keV was 30 HU. The median iodine dose was lower in the optimized DECTA group (13 g) compared with conventional DECTA (19 g) and SECTA (26 g) groups (P < .017 for each comparison). The median aortic CT numbers were higher in the order corresponding to conventional DECTA (655-769 HU), optimized DECTA (543-610 HU), and SECTA (343-359 HU) groups (P < .001). Conclusion The optimized trigger threshold of 30 HU for bolus-tracking technique during dual-energy CT angiography at 40 keV achieved lower iodine load while maintaining aortic enhancement. ©RSNA, 2021 Online supplemental material is available for this article. See also the editorial by Malayeri in this issue.
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Affiliation(s)
- Yoshifumi Noda
- From the Departments of Radiology (Y.N., F.N., N.K., M.M.) and Frontier Science for Imaging (F.H.), Gifu University, 1-1 Yanagido, Gifu 501-1194, Japan; Department of Radiology Services (R.S., T.M.) and Innovative and Clinical Research Promotion Center (T.I.), Gifu University Hospital, Gifu, Japan; and Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Mass (A.R.K.)
| | - Fumihiko Nakamura
- From the Departments of Radiology (Y.N., F.N., N.K., M.M.) and Frontier Science for Imaging (F.H.), Gifu University, 1-1 Yanagido, Gifu 501-1194, Japan; Department of Radiology Services (R.S., T.M.) and Innovative and Clinical Research Promotion Center (T.I.), Gifu University Hospital, Gifu, Japan; and Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Mass (A.R.K.)
| | - Nobuyuki Kawai
- From the Departments of Radiology (Y.N., F.N., N.K., M.M.) and Frontier Science for Imaging (F.H.), Gifu University, 1-1 Yanagido, Gifu 501-1194, Japan; Department of Radiology Services (R.S., T.M.) and Innovative and Clinical Research Promotion Center (T.I.), Gifu University Hospital, Gifu, Japan; and Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Mass (A.R.K.)
| | - Ryosuke Suzuki
- From the Departments of Radiology (Y.N., F.N., N.K., M.M.) and Frontier Science for Imaging (F.H.), Gifu University, 1-1 Yanagido, Gifu 501-1194, Japan; Department of Radiology Services (R.S., T.M.) and Innovative and Clinical Research Promotion Center (T.I.), Gifu University Hospital, Gifu, Japan; and Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Mass (A.R.K.)
| | - Toshiharu Miyoshi
- From the Departments of Radiology (Y.N., F.N., N.K., M.M.) and Frontier Science for Imaging (F.H.), Gifu University, 1-1 Yanagido, Gifu 501-1194, Japan; Department of Radiology Services (R.S., T.M.) and Innovative and Clinical Research Promotion Center (T.I.), Gifu University Hospital, Gifu, Japan; and Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Mass (A.R.K.)
| | - Takuma Ishihara
- From the Departments of Radiology (Y.N., F.N., N.K., M.M.) and Frontier Science for Imaging (F.H.), Gifu University, 1-1 Yanagido, Gifu 501-1194, Japan; Department of Radiology Services (R.S., T.M.) and Innovative and Clinical Research Promotion Center (T.I.), Gifu University Hospital, Gifu, Japan; and Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Mass (A.R.K.)
| | - Fuminori Hyodo
- From the Departments of Radiology (Y.N., F.N., N.K., M.M.) and Frontier Science for Imaging (F.H.), Gifu University, 1-1 Yanagido, Gifu 501-1194, Japan; Department of Radiology Services (R.S., T.M.) and Innovative and Clinical Research Promotion Center (T.I.), Gifu University Hospital, Gifu, Japan; and Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Mass (A.R.K.)
| | - Avinash R Kambadakone
- From the Departments of Radiology (Y.N., F.N., N.K., M.M.) and Frontier Science for Imaging (F.H.), Gifu University, 1-1 Yanagido, Gifu 501-1194, Japan; Department of Radiology Services (R.S., T.M.) and Innovative and Clinical Research Promotion Center (T.I.), Gifu University Hospital, Gifu, Japan; and Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Mass (A.R.K.)
| | - Masayuki Matsuo
- From the Departments of Radiology (Y.N., F.N., N.K., M.M.) and Frontier Science for Imaging (F.H.), Gifu University, 1-1 Yanagido, Gifu 501-1194, Japan; Department of Radiology Services (R.S., T.M.) and Innovative and Clinical Research Promotion Center (T.I.), Gifu University Hospital, Gifu, Japan; and Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Mass (A.R.K.)
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Noda Y, Nakamura F, Yasuda N, Miyoshi T, Kawai N, Kawada H, Hyodo F, Matsuo M. Advantages and disadvantages of single-source dual-energy whole-body CT angiography with 50% reduced iodine dose at 40 keV reconstruction. Br J Radiol 2021; 94:20201276. [PMID: 33617294 DOI: 10.1259/bjr.20201276] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES To assess the feasibility of whole-body dual-energy computed tomographic angiography (DECTA) at 40 keV with 50% reduced iodine dose protocol. METHODS Whole-body CTA was performed in 65 patients; 31 of these patients underwent 120 kVp single-energy computed tomographic angiography (SECTA) with standard iodine dose (600 mgI/kg) and 34 with 40 keV DECTA with 50% reduced iodine dose (300 mgI/kg). SECTA data were reconstructed with adaptive statistical iterative reconstruction of 40% (SECTA group), and DECTA data were reconstructed with adaptive statistical iterative reconstruction of 40% (DECTA-40% group) and 80% (DECTA-80% group). CT numbers of the thoracic and abdominal aorta, iliac artery, background noise, signal-to-noise ratio (SNR), and arterial depiction were compared among the three groups. The CT dose index volumes (CTDIvol) for the thorax, abdomen, and pelvis were compared between SECTA and DECTA protocols. RESULTS The vascular CT numbers and background noise were found to be significantly higher in DECTA groups than in the SECTA group (p < 0.001). SNR was significantly higher in the order corresponding to DECTA-80%, SECTA, and DECTA-40% (p < 0.001). The arterial depiction was comparable in almost all arteries; however, intrapelvic arterial depiction was significantly worse in DECTA groups than in the SECTA group (p < 0.0001-0.017). Unlike the pelvic region (p = 0.055), CTDIvol for the thorax (p < 0.0001) and abdomen (p = 0.0031) were significantly higher in the DECTA protocol than in the SECTA protocol. CONCLUSION DECTA at 40 keV with 50% reduced iodine dose provided higher vascular CT numbers and SNR than SECTA, and almost comparable arterial depiction, but had a degraded intrapelvic arterial depiction and required a larger radiation dose. ADVANCES IN KNOWLEDGE DECTA enables 50% reduction of iodine dose while maintaining image quality, arterial depiction in almost all arteries, vascular CT numbers, and SNR; however, it does not allow clear visualization of intrapelvic arteries, requiring a slightly larger radiation dose compared with SECTA with standard iodine dose.
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Affiliation(s)
| | | | | | | | | | | | - Fuminori Hyodo
- Department of Radiology, Frontier Science for Imaging, Gifu University, Gifu, Japan
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Kawada H, Goshima S, Sakurai K, Noda Y, Kajita K, Tanahashi Y, Kawai N, Ishida N, Shimabukuro K, Doi K, Matsuo M. Utility of Noncontrast Magnetic Resonance Angiography for Aneurysm Follow-Up and Detection of Endoleaks after Endovascular Aortic Repair. Korean J Radiol 2020; 22:513-524. [PMID: 33543842 PMCID: PMC8005350 DOI: 10.3348/kjr.2020.0001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Revised: 06/02/2020] [Accepted: 06/22/2020] [Indexed: 11/17/2022] Open
Abstract
Objective To assess the noncontrast two-dimensional single-shot balanced turbo-field-echo magnetic resonance angiography (b-TFE MRA) features of the abdominal aortic aneurysm (AAA) status following endovascular aneurysm repair (EVAR) and evaluate to detect endoleaks (ELs). Materials and Methods We examined four aortic stent-grafts in a phantom study to assess the degree of metallic artifacts. We enrolled 46 EVAR-treated patients with AAA and/or common iliac artery aneurysm who underwent both computed tomography angiography (CTA) and b-TFE MRA after EVAR. Vascular measurements on CTA and b-TFE MRA were compared, and signal intensity ratios (SIRs) of the aneurysmal sac were correlated with the size changes in the AAA after EVAR (AAA prognoses). Furthermore, we examined six feasible b-TFE MRA features for the assessment of ELs. Results There were robust intermodality (r = 0.92–0.99) correlations and interobserver (intraclass correlation coefficient = 0.97–0.99) agreement. No significant differences were noted between SIRs and aneurysm prognoses. Moreover, “mottled high-intensity” and “creeping high-intensity with the low-band rim” were recognized as significant imaging findings suspicious for the presence of ELs (p < 0.001), whereas “no signal black spot” and “layered high-intensity area” were determined as significant for the absence of ELs (p < 0.03). Based on the two positive features, sensitivity, specificity, and accuracy for the detection of ELs were 77.3%, 91.7%, and 84.8%, respectively. Furthermore, the k values (0.40–0.88) displayed moderate-to-almost perfect agreement. Conclusion Noncontrast MRA could be a promising imaging modality for ascertaining patient follow-up after EVAR.
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Affiliation(s)
- Hiroshi Kawada
- Department of Radiology, Gifu University Hospital, Gifu, Japan
| | - Satoshi Goshima
- Department of Radiology, Gifu University Hospital, Gifu, Japan.,Department of Diagnostic Radiology and Nuclear Medicine, Hamamatsu University School of Medicine, Hamamatsu, Japan.
| | - Kota Sakurai
- Department of Radiology, Chuno Kosei Hospital, Seki, Japan
| | - Yoshifumi Noda
- Department of Radiology, Gifu University Hospital, Gifu, Japan
| | - Kimihiro Kajita
- Department of Radiology Services, Gifu University Hospital, Gifu, Japan
| | | | - Nobuyuki Kawai
- Department of Radiology, Gifu University Hospital, Gifu, Japan
| | - Narihiro Ishida
- Department of General and Cardiothoracic Surgery, Gifu University Hospital, Gifu, Japan
| | - Katsuya Shimabukuro
- Department of General and Cardiothoracic Surgery, Gifu University Hospital, Gifu, Japan
| | - Kiyoshi Doi
- Department of General and Cardiothoracic Surgery, Gifu University Hospital, Gifu, Japan
| | - Masayuki Matsuo
- Department of Radiology, Gifu University Hospital, Gifu, Japan
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Saat TC, van der Pluijm I, Ridwan Y, van Damme-van den Engel S, van Heijningen PM, Clahsen-van Groningen MC, Verhagen HJM, IJzermans JNM, Essers J, de Bruin RWF. Pre-Operative Fasting Provides Long Term Protection Against Chronic Renal Damage Induced by Ischaemia Reperfusion Injury in Wild Type and Aneurysm Prone Fibulin-4 Mice. Eur J Vasc Endovasc Surg 2020; 60:905-915. [PMID: 33032926 DOI: 10.1016/j.ejvs.2020.08.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Revised: 07/06/2020] [Accepted: 08/11/2020] [Indexed: 12/31/2022]
Abstract
OBJECTIVE Renal ischaemia reperfusion injury (IRI) is inevitable during open repair of pararenal aortic aneurysms. Pre-operative fasting potently increases resistance against IRI. The effect of fasting on IRI was examined in a hypomorphic Fibulin-4 mouse model (Fibulin-4+/R), which is predisposed to develop aortic aneurysms. METHODS Wild type (WT) and Fibulin-4+/R mice were either fed ad libitum (AL) or fasted for two days before renal IRI induction by temporary clamping of the renal artery and vein of both kidneys. Six hours, 48 h, and seven days post-operatively, serum urea levels, renal histology, and mRNA expression levels of inflammatory and injury genes were determined to assess kidney function and damage. Additionally, matrix metalloproteinase activity in the kidney was assessed six months after IRI. RESULTS Two days of fasting improved survival the first week after renal IRI in WT mice compared with AL fed mice. Short term AL fed Fibulin-4+/R mice showed improved survival and kidney function compared with AL fed WT mice, which could not be further enhanced by fasting. Both fasted WT and Fibulin-4+/R mice showed improved survival, kidney function and morphology compared with AL fed mice six months after renal IRI. Fibulin-4+/R kidneys of fasted mice showed reduced apoptosis together with increased matrix metalloprotease activity levels compared with AL fed Fibulin-4+/R mice, indicative of increased matrix remodelling. CONCLUSION Fibulin-4+/R mice are naturally protected against the short-term, but not long-term, consequences of renal IRI. Pre-operative fasting protects against renal IRI and prevents (long-term) deterioration of kidney function and morphology in both WT and Fibulin-4+/R mice. These data suggest that pre-operative fasting may decrease renal damage in patients undergoing open abdominal aneurysm repair.
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Affiliation(s)
- Tanja C Saat
- Department of Surgery, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Ingrid van der Pluijm
- Department of Vascular Surgery, Erasmus University Medical Center, Rotterdam, the Netherlands; Department of Molecular Genetics, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Yanto Ridwan
- Department of Molecular Genetics, Erasmus University Medical Center, Rotterdam, the Netherlands; Department of Radiology and Nuclear Medicine, Erasmus University Medical Center, Rotterdam, the Netherlands
| | | | - Paula M van Heijningen
- Department of Molecular Genetics, Erasmus University Medical Center, Rotterdam, the Netherlands
| | | | - Hence J M Verhagen
- Department of Vascular Surgery, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Jan N M IJzermans
- Department of Surgery, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Jeroen Essers
- Department of Vascular Surgery, Erasmus University Medical Center, Rotterdam, the Netherlands; Department of Molecular Genetics, Erasmus University Medical Center, Rotterdam, the Netherlands; Department of Radiation Oncology, Erasmus University Medical Center, Rotterdam, the Netherlands.
| | - Ron W F de Bruin
- Department of Surgery, Erasmus University Medical Center, Rotterdam, the Netherlands.
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Cho IJ, Lee J, Park J, Lee SE, Ahn CM, Ko YG, Choi D, Chang HJ. Feasibility and accuracy of a novel automated three-dimensional ultrasonographic analysis system for abdominal aortic aneurysm: comparison with two-dimensional ultrasonography and computed tomography. Cardiovasc Ultrasound 2020; 18:24. [PMID: 32611427 PMCID: PMC7330975 DOI: 10.1186/s12947-020-00207-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Accepted: 06/23/2020] [Indexed: 01/16/2023] Open
Abstract
Background Accurate measurement of the maximum aortic diameter (Dmax) is crucial for patients with abdominal aortic aneurysm (AAA). Aortic computed tomography (CT) provides accurate Dmax values by three-dimensional (3-D) reconstruction but may cause nephrotoxicity because of contrast use and radiation hazard. We aimed to evaluate the accuracy of a novel semi-automated 3-D ultrasonography (3-D US) system compared with that of CT as a reference. Methods Patients with AAA (n = 59) or individuals with normal aorta (n = 18) were prospectively recruited in an outpatient setting. Two-dimensional ultrasonography (2-D US) and 3-D US images were acquired with a single-sweep volumetric transducer. The analysis was performed offline with a software. Dmax and the vessel area of the Dmax slice were measured with 2-D US, 3-D US, and CT. The lumen and thrombus areas of the Dmax slice were also measured in 40 patients with intraluminal thrombus. Vessel and thrombus volumes were measured using 3-D US and CT. Results The Dmax values from 3-D US demonstrated better agreement (R2 = 0.984) with the CT values than with the 2-D US values (R2 = 0.938). Overall, 2-D US underestimated Dmax compared with 3-D US (32.3 ± 12.1 mm vs. 35.1 ± 12.0 mm). The Bland-Altman analysis of the 3-D US values, revealed better agreement with the CT values (2 standard deviations [SD], 2.9 mm) than with the 2-D US values (2 SD, 5.4 mm). The vessel, lumen, and thrombus areas all demonstrated better agreement with CT than with 2-D US (R2 = 0.986 vs. 0.960 for the vessel, R2 = 0.891 vs. 0.837 for the lumen, and R2 = 0.977 vs. 0.872 for the thrombus). The thrombus volume assessed with 3-D US showed good correlation with the CT value (R2 = 0.981 and 2 SD in the Bland-Altman analysis: 13.6 cm3). Conclusions Our novel semi-automated 3-D US analysis system provides more accurate Dmax values than 2-D US and provides precise volumetric data, which were not evaluable with 2-D US. The application of the semi-automated 3-D US analysis system in abdominal aorta assessment is easy and accurate.
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Affiliation(s)
- In-Jeong Cho
- Division of Cardiology, Department of Internal Medicine, Ewha Womans University Seoul Hospital, College of Medicine, Ewha Womans University, Seoul, Republic of Korea
| | - Jinyong Lee
- Ultrasound R&D Group, Samsung Medison Co., Ltd, Seoul, Republic of Korea
| | - Jinki Park
- Ultrasound R&D Group, Samsung Medison Co., Ltd, Seoul, Republic of Korea
| | - Sang-Eun Lee
- Division of Cardiology, Department of Internal Medicine, Ewha Womans University Seoul Hospital, College of Medicine, Ewha Womans University, Seoul, Republic of Korea
| | - Chul-Min Ahn
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea
| | - Young-Guk Ko
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea
| | - Donghoon Choi
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea
| | - Hyuk-Jae Chang
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea.
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Yoshida M, Nakaura T, Sentaro T, Tanoue S, Inada H, Utsunomiya D, Sakaino N, Harada K, Yamashita Y. Prospective Comparison of 70-kVp Single-Energy CT versus Dual-Energy CT: Which is More Suitable for CT Angiography with Low Contrast Media Dosage? Acad Radiol 2020; 27:e116-e122. [PMID: 31537504 DOI: 10.1016/j.acra.2019.07.016] [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: 03/26/2019] [Revised: 07/22/2019] [Accepted: 07/22/2019] [Indexed: 11/25/2022]
Abstract
RATIONALE AND OBJECTIVES To compare the objective and subjective image qualities between single-energy computed tomography (CT) at 70 kVp and virtual monoenergetic imaging (VMI) of dual-source dual-energy CT for CT angiography with 180 mgI/kg. MATERIALS AND METHODS Total 63 patients scanned with 180 mgI/kg were randomly divided into two groups: Group A (32 patients) underwent CT angiography at 70-kVp, and Group B (31 patients) underwent dual-energy CT. VMI sets were generated at 10-keV increments between 40 and 100 keV. We calculated aortic attenuation, contrast-to-noise-ratio (CNR), signal-to-noise-ratio, figure of merit of CNR, and effective dose for each protocol. Three radiologists scored overall image quality and various arteries' visibility using a four-point scale. Quantitative and qualitative comparisons between 70 kVp and VMI with the highest CNR were performed with the two-tailed t test or Kruskal-Wallis test. RESULTS The 40-keV images offered the highest CNR among VMIs. Aortic attenuation at 70 kVp was significantly lower than that at 40 keV (p < 0.001). However, the signal-to-noise-ratio, CNR, and figure of merit of CNR were significantly higher at 70 kVp than those at 40-keV (p < 0.001, p < 0.05, and p < 0.05, respectively). The effective dose of each group was almost equal. The qualitative visibility scores for various arteries, except the ascending and upper-abdominal aorta, were also better at 70 kVp than those at 40 keV. CONCLUSION Aortic attenuation at 70 kVp with 180 mg I/kg was lower than that of VMI at 40 keV, and the objective and subjective image qualities were higher at 70 kVp than those at 40 keV.
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Wu ZN, Guan XL, Xu SJ, Wang XL, Li HY, Gong M, Zhang HJ. Does preoperative serum creatinine affect the early surgical outcomes of acute Stanford type A aortic dissection? J Chin Med Assoc 2020; 83:266-271. [PMID: 31990819 DOI: 10.1097/jcma.0000000000000264] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Acute Stanford type A aortic dissection is a lethal disease requiring surgery. Evidence regarding the effects of preoperative creatinine in mortality is limited, and few studies have evaluated the effect of postoperative dialysis treatment on it. METHODS In this cohort study, we continuously recruited 632 surgical patients who were treated for acute type A aortic dissection in our hospital between January 2015 and May 2017. The preoperative level of serum creatinine was measured. All patients were followed up after surgery for 30 days to determine early mortality. RESULTS The 30-day mortality after surgery increased with elevated levels of preoperative serum creatinine. Median (interquartile range) serum creatinine levels in survivors were 9.61 μmol/dL (7.28-12.62 μmol/dL) versus 13.41 μmol/dL (10.28-20.63 μmol/dL) in death (p < 0.01). Adjusted odds ratios for increasing per μmol/dL serum creatinine were 1.09 (95% confidence interval, 1.03-1.15). We also found that the effect of preoperative creatinine on 30-day mortality was diminished by dialysis treatment after surgery. CONCLUSION Preoperative serum creatinine predicts outcome in patients undergoing surgery for Stanford type A aortic dissection, and postoperative dialysis treatment can reduce its hazard.
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Affiliation(s)
- Zi-Ning Wu
- Department of Cardiac surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
- Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China
- Beijing Lab for Cardiovascular Precision Medicine, Beijing, China
- Beijing Aortic Disease Center, Cardiovascular Surgery Center, Beijing, China
| | - Xin-Liang Guan
- Department of Cardiac surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
- Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China
- Beijing Lab for Cardiovascular Precision Medicine, Beijing, China
- Beijing Aortic Disease Center, Cardiovascular Surgery Center, Beijing, China
| | - Shi-Jun Xu
- Department of Cardiac surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
- Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China
- Beijing Lab for Cardiovascular Precision Medicine, Beijing, China
- Beijing Aortic Disease Center, Cardiovascular Surgery Center, Beijing, China
| | - Xiao-Long Wang
- Department of Cardiac surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
- Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China
- Beijing Lab for Cardiovascular Precision Medicine, Beijing, China
- Beijing Aortic Disease Center, Cardiovascular Surgery Center, Beijing, China
| | - Hai-Yang Li
- Department of Cardiac surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
- Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China
- Beijing Lab for Cardiovascular Precision Medicine, Beijing, China
- Beijing Aortic Disease Center, Cardiovascular Surgery Center, Beijing, China
| | - Ming Gong
- Department of Cardiac surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
- Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China
- Beijing Lab for Cardiovascular Precision Medicine, Beijing, China
- Beijing Aortic Disease Center, Cardiovascular Surgery Center, Beijing, China
| | - Hong-Jia Zhang
- Department of Cardiac surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
- Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China
- Beijing Lab for Cardiovascular Precision Medicine, Beijing, China
- Beijing Aortic Disease Center, Cardiovascular Surgery Center, Beijing, China
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11
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Dong N, Piao H, Li B, Xu J, Wei S, Liu K. Poor management of hypertension is an important precipitating factor for the development of acute aortic dissection. J Clin Hypertens (Greenwich) 2019; 21:804-812. [PMID: 31106981 DOI: 10.1111/jch.13556] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Revised: 04/03/2019] [Accepted: 04/21/2019] [Indexed: 12/22/2022]
Abstract
Hypertension is considered a key risk factor for acute aortic dissection (AAD). However, there is limited evidence demonstrating if hypertension management affects AAD development. The objective of this study was to investigate the role of hypertension management in AAD development in a Chinese population. A total of 825 AAD patients and 3300 age- and sex-matched controls were included. The authors analyzed data on demographics, chronic comorbidities, and hypertension management of all participants. Multiple logistic regression analysis was used to estimate the adjusted odds ratios (AOR) and 95% confidence intervals (95% CI) for the relationship between chronic comorbidities, as well as the management of hypertension and AAD risk. After adjusting for other related factors, multivariate logistic regression identified hypertension, chronic kidney disease, Marfan syndrome, history of cardiovascular surgery, and history of smoking as risk factors for AAD. Among the identified risk factors, hypertension was an important and controllable risk factor for AAD development. Thus, the authors further evaluated how hypertension management affects AAD development. A total of 848 controls and 585 AAD patients with hypertension were enrolled in this part of the study. Hypertensive patients with AAD had a longer history, higher stage, poorer medication compliance, and poor control rates of blood pressure, among which poor medication compliance (Irregular vs Regular P < 0.001; Never treated vs Regular P < 0.001) and uncontrolled hypertension (P < 0.001) significantly increased the risk of AAD development. In conclusion, uncontrolled hypertension and poor medication compliance are important precipitating and controllable factors for AAD development.
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Affiliation(s)
- Ning Dong
- Department of Cardiovascular Surgery, Second Hospital of Bethune, Jilin University, Changchun, China.,Department of Emergency Medicine, First Hospital of Bethune, Jilin University, Changchun, China
| | - Hulin Piao
- Department of Cardiovascular Surgery, Second Hospital of Bethune, Jilin University, Changchun, China
| | - Bo Li
- Department of Cardiovascular Surgery, Second Hospital of Bethune, Jilin University, Changchun, China
| | - Jian Xu
- Department of Cardiovascular Surgery, Second Hospital of Bethune, Jilin University, Changchun, China
| | - Shibo Wei
- Department of Cardiovascular Surgery, Second Hospital of Bethune, Jilin University, Changchun, China
| | - Kexiang Liu
- Department of Cardiovascular Surgery, Second Hospital of Bethune, Jilin University, Changchun, China
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Patino M, Parakh A, Lo GC, Agrawal M, Kambadakone AR, Oliveira GR, Sahani DV. Virtual Monochromatic Dual-Energy Aortoiliac CT Angiography With Reduced Iodine Dose: A Prospective Randomized Study. AJR Am J Roentgenol 2019; 212:467-474. [DOI: 10.2214/ajr.18.19935] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
Affiliation(s)
- Manuel Patino
- Department of Radiology, Division of Abdominal Imaging, Massachusetts General Hospital, Harvard Medical School, 55 Fruit St, Boston, MA 02114
| | - Anushri Parakh
- Department of Radiology, Division of Abdominal Imaging, Massachusetts General Hospital, Harvard Medical School, 55 Fruit St, Boston, MA 02114
| | - Grace C. Lo
- Department of Radiology, Division of Abdominal Imaging, Massachusetts General Hospital, Harvard Medical School, 55 Fruit St, Boston, MA 02114
| | - Mukta Agrawal
- Department of Radiology, Division of Abdominal Imaging, Massachusetts General Hospital, Harvard Medical School, 55 Fruit St, Boston, MA 02114
| | - Avinash R. Kambadakone
- Department of Radiology, Division of Abdominal Imaging, Massachusetts General Hospital, Harvard Medical School, 55 Fruit St, Boston, MA 02114
| | - George R. Oliveira
- Department of Radiology, Division of Abdominal Imaging, Massachusetts General Hospital, Harvard Medical School, 55 Fruit St, Boston, MA 02114
| | - Dushyant V. Sahani
- Department of Radiology, Division of Abdominal Imaging, Massachusetts General Hospital, Harvard Medical School, 55 Fruit St, Boston, MA 02114
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13
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Ramachandran S, Afshan PT, Pitchai S, Goura P, Ramachandran H. Clinical profile of abdominal aortic aneurysms undergoing open surgical repair: A single-center experience. INDIAN JOURNAL OF VASCULAR AND ENDOVASCULAR SURGERY 2019. [DOI: 10.4103/ijves.ijves_96_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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14
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Eghbalzadeh K, Sabashnikov A, Weber C, Zeriouh M, Djordjevic I, Merkle J, Shostak O, Saenko S, Majd P, Liakopoulos O, Rahmanian PB, Madershahian N, Choi YH, Kuhn-Régnier F, Wippermann J, Wahlers T. Impact of preoperative elevated serum creatinine on long-term outcome of patients undergoing aortic repair with Stanford A dissection: a retrospective matched pair analysis. Ther Adv Cardiovasc Dis 2018; 12:289-298. [PMID: 30227769 DOI: 10.1177/1753944718798345] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND The aim of the present study was to determine whether raised preoperative serum creatinine affected the long-term outcome in patients undergoing surgical aortic repair for Stanford A acute aortic dissection (AAD). METHODS A total of 240 patients diagnosed with Stanford A AAD underwent surgical repair from January 2006 to April 2015. A propensity score matching was applied, resulting in 73 pairs consisting of one group with normal and one group with preoperative elevated creatinine levels. The cohorts were well balanced for baseline and preoperative clinical characteristics. Both groups were compared regarding their early postoperative variables, as well as estimated survival with up to 9-year follow up. Also, the impact of acute postoperative kidney injury and its severity on long-term survival was analyzed. RESULTS The proportion of patients suffering Stanford A AAD with raised creatinine levels was 31.3% ( n = 75). After propensity matching, there were no statistically significant differences regarding demographics, comorbidities, preoperative baseline and clinical characteristics. Postoperatively matched patients with elevated creatinine had longer intensive care unit ( p < 0.001) and total hospital stay ( p = 0.002), prolonged intubation times ( p = 0.014), higher need for hemofiltration ( p < 0.001), higher incidence of temporary neurological disorders ( p = 0.16), infection ( p = 0.005), and trend toward higher incidence of sepsis ( p = 0.097). However, there were no significant differences regarding 30-day mortality (20.5% versus 20.5%, p = 1.000) and long-term overall survival. Further, neither the incidence nor the different stages of acute kidney injury according to the Acute Kidney Injury Network showed any statistically significant differences in terms of long-term survival for both groups [log rank p = 0.636, Breslow (generalized Wilcoxon) p = 0.470, Tarone-Ware p = 0.558]. CONCLUSIONS Patients with elevated creatinine levels undergoing surgical repair for Stanford A AAD demonstrate higher rate of early postoperative complications. However, 30-day mortality and long-term survival in this patient cohort is not significantly impaired.
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Affiliation(s)
- Kaveh Eghbalzadeh
- Department of Cardiothoracic Surgery, University Hospital of Cologne, Kerpener Str. 62, Cologne 50937, Germany
| | - Anton Sabashnikov
- Department of Cardiothoracic Surgery, University Hospital of Cologne, Cologne, Germany
| | - Carolyn Weber
- Department of Cardiothoracic Surgery, University Hospital of Cologne, Cologne, Germany
| | - Mohamed Zeriouh
- Department of Cardiothoracic Surgery, University Hospital of Cologne, Cologne, Germany
| | - Ilija Djordjevic
- Department of Cardiothoracic Surgery, University Hospital of Cologne, Cologne, Germany
| | - Julia Merkle
- Department of Cardiothoracic Surgery, University Hospital of Cologne, Cologne, Germany
| | - Olga Shostak
- Department of Cardiothoracic Surgery, University Hospital of Cologne, Cologne, Germany
| | - Sergey Saenko
- Department of Cardiothoracic Surgery, University Hospital of Cologne, Cologne, Germany
| | - Payman Majd
- Department of Vascular Surgery, University Hospital of Cologne, Cologne, Germany
| | - Oliver Liakopoulos
- Department of Cardiothoracic Surgery, University Hospital of Cologne, Cologne, Germany
| | - Parwis B Rahmanian
- Department of Cardiothoracic Surgery, University Hospital of Cologne, Cologne, Germany
| | - Navid Madershahian
- Department of Cardiothoracic Surgery, University Hospital of Cologne, Cologne, Germany
| | - Yeong-Hoon Choi
- Department of Cardiothoracic Surgery, University Hospital of Cologne, Cologne, Germany
| | | | - Jens Wippermann
- Department of Cardiothoracic Surgery, University Hospital of Magdeburg, Magdeburg, Germany
| | - Thorsten Wahlers
- Department of Cardiothoracic Surgery, University Hospital of Cologne, Cologne, Germany
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15
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Tsialtas D, Bolognesi MG, Volpi R, Bolognesi R. Atherosclerotic vascular diseases have really the same risk factors? Comparison between large abdominal aortic aneurysm and obstructive non-coronary arterial disease. Vascular 2017; 25:629-634. [PMID: 28509621 DOI: 10.1177/1708538117708474] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objectives The purpose of this study was to investigate whether there are differences among clinical conditions and traditional atherosclerotic risk factors between patients with large abdominal aortic aneurysm and those with occlusive non-coronary arterial disease. Methods We clinically examined 519 patients with asymptomatic abdominal aortic aneurysm and 672 with severe obstructive arterial diseases before surgical repair. Results In patients with abdominal aortic aneurysm, we identified a clear predominance of males ( p < 0.001), more alcohol consumers ( p < 0.05), higher values of diastolic blood pressure ( p < 0.05), higher values of serum creatinine ( p < 0.005), more hyperuricemic patients ( p < 0.005) and less diabetics ( p < 0.001). In patients with occlusive atherosclerotic vasculopathies, we observed more smokers ( p < 0.05), higher systolic blood pressure and more hypertensives ( p < 0.05 respectively) and a prevalence of hypertriglyceridemia ( p < 0.05). Conclusions Patients with abdominal aortic aneurysm were mostly males with diastolic hypertension, impaired renal function and less diabetics, while patients with occlusive arteriopathy were more smokers, hypertensives and more hypertriglyceridemics.
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Affiliation(s)
- Dimitri Tsialtas
- Dipartimento di Medicina Interna e, Scienze Biomediche, Sezione di Cardiologia, Università degli Studi di Parma, Parma, Italy
| | - Maria Giulia Bolognesi
- Dipartimento di Medicina Interna e, Scienze Biomediche, Sezione di Cardiologia, Università degli Studi di Parma, Parma, Italy
| | - Riccardo Volpi
- Dipartimento di Medicina Interna e, Scienze Biomediche, Sezione di Cardiologia, Università degli Studi di Parma, Parma, Italy
| | - Roberto Bolognesi
- Dipartimento di Medicina Interna e, Scienze Biomediche, Sezione di Cardiologia, Università degli Studi di Parma, Parma, Italy
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16
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Estimation of V-POSSUM and E-PASS Scores in Prediction of Acute Kidney Injury in Patients after Elective Open Abdominal Aortic Aneurysm Surgery. Ann Vasc Surg 2017; 42:189-197. [PMID: 28359795 DOI: 10.1016/j.avsg.2017.02.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2016] [Accepted: 02/28/2017] [Indexed: 12/15/2022]
Abstract
BACKGROUND V-POSSUM and E-PASS scoring systems are usually used to predict morbidity and early mortality in surgical patients. We conducted this study to assess the validity of the V-POSSUM and E-PASS scores in predicting risk of acute kidney injury (AKI) development in patients undergoing elective open abdominal aortic aneurysm (AAA) repair. METHODS We studied a consecutive series of 171 patients with AAA, qualified for elective open infrarenal repair. Patients underwent a thorough examination, and the physiological and surgical stress components of the V-POSSUM and E-PASS scores were calculated. The classification of patients in terms of postoperative AKI was performed in accordance with KDIGO criteria. RESULTS AKI was recognized in 62 patients. In these patients, we found significantly higher physiological and surgical stress components of V-POSSUM and E-PASS scores in relation to patients without AKI. ROC analysis showed that the E-PASS score with a cutoff point ≥0.796 and the V-POSSUM score (morbidity) with a cutoff point ≥77.2% with sensitivity of 75.8% and 74.2%, respectively, and with specificity of 83.5% for both, identified patients with postoperative AKI. CONCLUSIONS V-POSSUM and E-PASS scores have similar good properties in predicting postoperative AKI in patients undergoing elective open AAA repair.
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17
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Shuman WP, O'Malley RB, Busey JM, Ramos MM, Koprowicz KM. Prospective comparison of dual-energy CT aortography using 70% reduced iodine dose versus single-energy CT aortography using standard iodine dose in the same patient. Abdom Radiol (NY) 2017; 42:759-765. [PMID: 28084544 DOI: 10.1007/s00261-016-1041-z] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To compare dual-energy computed tomography (DECT) aortography using a 70% reduced iodine dose to single-energy CT (SECT) aortography using a standard iodine dose in the same patient. METHODS Twenty-one patients with a prior SECT aortography using standard iodine dose had DECT aortography using 70% reduced iodine dose. Section 120 kVp images were compared to DECT images reconstructed at both 50 and 77 keV. Reviewers measured image noise and attenuation in the aorta at eight locations from proximal to distal and subjectively scored vascular enhancement on a four-point scale. Signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) were calculated. The volume CT dose index (CTDIvol) for each exam was recorded. RESULTS Mean iodine dose was 50 g for SECT and 15 g for DECT (70% reduction). Mean aortic attenuation was similar for section 120 kVp (350 ± 67 HU) and DECT 50 keV (338 ± 57 HU, p = 0.547) but was lower at 77 keV (152 ± 23 HU). Measured image noise was greatest at 50 keV (12 ± 5 HU) and was lowest at 77 keV (7 ± 2 HU, p > 0.001). There was no difference in SNR or CNR between 120 kVp and 50 keV (p > 0.05). Mean subjective vascular enhancement scores for SECT were between good and excellent (3.33-3.69), and for DECT at 50 keV were between moderate and good (2.54-2.93, p < 0.0001). CTDIvol was 13.6 mGy for SECT and 13.1 mGy for DECT (p = 0.637). CONCLUSION 70% Reduced iodine DECT aortography may result in similar aortic attenuation, CNR, SNR, and lower although acceptable subjective image scores when compared to standard iodine SECT aortography in the same patient.
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Affiliation(s)
- William P Shuman
- Department of Radiology, University of Washington, 1959 NE Pacific Street, Box 357115, Seattle, WA, 98195, USA.
| | - Ryan B O'Malley
- Department of Radiology, University of Washington, 1959 NE Pacific Street, Box 357115, Seattle, WA, 98195, USA
| | - Janet M Busey
- Department of Radiology, University of Washington, 1959 NE Pacific Street, Box 357115, Seattle, WA, 98195, USA
| | - Mario M Ramos
- Department of Radiology, University of Washington, 1959 NE Pacific Street, Box 357115, Seattle, WA, 98195, USA
| | - Kent M Koprowicz
- Department of Radiology, University of Washington, 1959 NE Pacific Street, Box 357115, Seattle, WA, 98195, USA
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18
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Prospective Comparison of Reduced-Iodine-Dose Virtual Monochromatic Imaging Dataset From Dual-Energy CT Angiography With Standard-Iodine-Dose Single-Energy CT Angiography for Abdominal Aortic Aneurysm. AJR Am J Roentgenol 2016; 207:W125-W132. [PMID: 27610820 DOI: 10.2214/ajr.15.15814] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
OBJECTIVE The purpose of this study was to compare the image quality of reduced-iodine-dose single-source dual-energy CT angiography (CTA) with that of standard-iodine-dose single-energy CTA in examinations of patients with abdominal aortic aneurysm and to assess the effect of the concentration of iodinated contrast medium on intravascular enhancement and image quality of reduced-iodine-dose CTA. SUBJECTS AND METHODS In a prospective randomized clinical trial, 66 consecutively registered patients with abdominal aortic aneurysm who had previously undergone single-energy CTA (30-37 g I) underwent follow-up CTA at a reduced dose (21-27 g I) of iodinated contrast medium of either 270 mg I/mL (n = 33) or 320 mg I/mL (n = 33). Two readers independently evaluated virtual monochromatic imaging datasets (40-140 keV) and single-energy CTA images for image quality and noise and their preference for optimal energy virtual monochromatic imaging dataset. A value of p < 0.05 was considered statistically significant. RESULTS All 66 dual-energy CTA examinations were rated diagnostic with mean image quality and image noise scores of 4.8 and 4.5 for reader 1 and 3.8 and 3.4 for reader 2 compared with single-energy CTA results of 4.5 and 4.2 for reader 1 and 4.5 and 4.1 for reader 2. Low-energy virtual monochromatic images (40-60 keV) from reduced-iodine-dose (28%) dual-energy CTA had significantly higher intravascular aortic attenuation (26-185%) and contrast-to-noise ratio (CNR) (20-25%) than standard-iodine-dose single-energy CTA images (p < 0.0001). No significant difference was found between patients who received 270 and those who received 320 mg I/mL with respect to intravascular aortic attenuation (p = 0.6331) or CNR (p = 0.9775). CONCLUSION Low-energy virtual monochromatic imaging datasets from reduced-iodine (24 g I) single-source dual-energy CTA of the abdomen provide up to 185% higher attenuation and 25% higher CNR than standard-iodine-dose (33.3 g I) single-energy CTA while offering a wide range of energy settings irrespective of the concentration of IV contrast medium used.
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Sasabuchi Y, Kimura N, Shiotsuka J, Komuro T, Mouri H, Ohnuma T, Asaka K, Lefor AK, Yasunaga H, Yamaguchi A, Adachi H, Sanui M. Long-Term Survival in Patients With Acute Kidney Injury After Acute Type A Aortic Dissection Repair. Ann Thorac Surg 2016; 102:2003-2009. [PMID: 27372373 DOI: 10.1016/j.athoracsur.2016.05.006] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2015] [Revised: 04/21/2016] [Accepted: 05/02/2016] [Indexed: 01/04/2023]
Abstract
BACKGROUND Although acute kidney injury (AKI) is known as a serious complication after operation for acute type A aortic dissection (AAAD), the long-term impact of AKI remains unclear. The aim of the present study is to investigate the long-term survival in patients with AKI after operation for AAAD. METHODS This study included 403 patients who underwent operation for AAAD from 1990 to 2011 at Jichi Medical University, Saitama Medical Center. Postoperative AKI was identified according to the Kidney Disease Improving Global Outcomes criteria. Kaplan-Meier survival analysis and Cox proportional hazards regression were modeled to analyze the association between the AKI stage and postoperative long-term survival. RESULTS Of 403 patients, 181 (44.9%) experienced postoperative AKI. Kaplan-Meier estimates for long-term survival were significantly different among patients without AKI and patients with stage 1, 2, and 3 AKI (p < 0.001). Hazard ratios of long-term survival for patients with stages 1, 2, and 3 AKI compared with patients without AKI were 1.38 (95% confidence interval [CI]: 0.84 to 2.26), 1.82 (95% CI: 0.95 to 3.51), and 3.79 (95% CI: 1.95 to 7.37), respectively. More patients with AKI died because of cardiovascular disease after discharge than patients without AKI (1.8% versus 6.0%, p = 0.03). CONCLUSIONS Stage 3 AKI is significantly associated with lower long-term survival after operation for AAAD. Patient follow-up after discharge that focuses on cardiovascular issues may benefit patients who survive AKI after AAAD operation.
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Affiliation(s)
- Yusuke Sasabuchi
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan; Department of Anesthesiology and Critical Care Medicine, Jichi Medical University Saitama Medical Center, Saitama, Japan.
| | - Naoyuki Kimura
- Department of Cardiovascular Surgery, Jichi Medical University Saitama Medical Center, Saitama, Japan
| | - Junji Shiotsuka
- Department of Anesthesiology and Critical Care Medicine, Jichi Medical University Saitama Medical Center, Saitama, Japan
| | - Tetsuya Komuro
- Department of Anesthesiology and Critical Care Medicine, Jichi Medical University Saitama Medical Center, Saitama, Japan
| | - Hideyuki Mouri
- Department of Anesthesiology and Critical Care Medicine, Jichi Medical University Saitama Medical Center, Saitama, Japan
| | - Tetsu Ohnuma
- Department of Anesthesiology and Critical Care Medicine, Jichi Medical University Saitama Medical Center, Saitama, Japan
| | - Kayo Asaka
- Department of Anesthesiology and Critical Care Medicine, Jichi Medical University Saitama Medical Center, Saitama, Japan
| | - Alan K Lefor
- Department of Surgery, Jichi Medical University, Tochigi, Japan
| | - Hideo Yasunaga
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
| | - Atsushi Yamaguchi
- Department of Cardiovascular Surgery, Jichi Medical University Saitama Medical Center, Saitama, Japan
| | - Hideo Adachi
- Department of Cardiovascular Surgery, Jichi Medical University Saitama Medical Center, Saitama, Japan
| | - Masamitsu Sanui
- Department of Anesthesiology and Critical Care Medicine, Jichi Medical University Saitama Medical Center, Saitama, Japan
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Mori K, Saida T, Sato F, Uchikawa Y, Konishi T, Ishiguro T, Hiyama T, Hoshiai S, Okamoto Y, Nasu K, Minami M. Endoleak detection after endovascular aneurysm repair using unenhanced MRI with flow suppression technique: Feasibility study in comparison with contrast-enhanced CT. Eur Radiol 2016; 27:336-344. [PMID: 27011375 DOI: 10.1007/s00330-016-4315-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2015] [Revised: 02/24/2016] [Accepted: 02/26/2016] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To evaluate the feasibility of unenhanced motion-sensitized-driven equilibrium (MSDE)-prepared balanced turbo field echo (BTFE) sequences for detecting endoleaks after endovascular aneurysm repair (EVAR). METHODS Forty-six patients treated with EVAR for aortic and/or iliac arterial aneurysms underwent contrast-enhanced CT and MSDE-prepared BTFE sequences with and without flow suppression. Two independent observers reviewed these sequences and their subtraction images and assigned confidence levels for detecting endoleaks. Relative contrast values were calculated by dividing signal intensities by those of paraspinal muscles. CT provided the reference standard. RESULTS CT showed types I and II endoleaks in one and ten patients, respectively. Areas under receiver operating characteristic curves were 0.92 and 0.97 for observers 1 and 2, respectively. Sensitivity, specificity, accuracy, positive predictive value and negative predictive value of both observers were 91 (10/11), 91(32/35), 91 (42/46), 77 (10/13) and 97 % (32/33), respectively. Relative contrast values of endoleaks and flowing blood significantly decreased by flow suppression on MSDE-prepared BTFE images (P = 0.002 and P < 0.0001 respectively), and were significantly higher than those of the excluded aneurysms on subtraction images (P = 0.003 and P = 0.001, respectively). CONCLUSIONS Unenhanced MSDE-prepared BTFE sequences are feasible for detecting endoleaks. KEY POINTS • Flow suppression significantly reduces endoleak signals on MSDE-prepared BTFE images. • Subtraction images of MSDE-prepared BTFE sequences ± flow suppression demonstrate endoleaks. • MSDE-prepared BTFE sequences indicate high diagnostic values (>90 %) except PPV (77 %). • MSDE-prepared BTFE sequences need further refinement to reduce false positives. • Endoleaks can be detected without contrast injection using MSDE-prepared BTFE sequences.
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Affiliation(s)
- Kensaku Mori
- Department of Radiology Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8575, Japan.
| | - Tsukasa Saida
- Department of Radiology Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8575, Japan
| | - Fujio Sato
- Department of Cardiovascular Surgery, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8575, Japan
| | - Yoko Uchikawa
- Department of Radiology, Hitachi General Hospital, 2-1-1 Jonancho, Hitachi, Ibaraki, 317-0077, Japan
| | - Takahiro Konishi
- Department of Radiology, University of Tsukuba Hospital, 2-1-1 Amakubo, Tsukuba, Ibaraki, 305-8576, Japan
| | - Toshitaka Ishiguro
- Department of Radiology, University of Tsukuba Hospital, 2-1-1 Amakubo, Tsukuba, Ibaraki, 305-8576, Japan
| | - Takashi Hiyama
- Department of Radiology, University of Tsukuba Hospital, 2-1-1 Amakubo, Tsukuba, Ibaraki, 305-8576, Japan
| | - Sodai Hoshiai
- Department of Radiology, Ibaraki Prefectural Central Hospital, 6528 Koibuchi, Kasama, Ibaraki, 309-1793, Japan
| | - Yoshikazu Okamoto
- Department of Radiology Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8575, Japan
| | - Katsuhiro Nasu
- Department of Radiology Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8575, Japan
| | - Manabu Minami
- Department of Radiology Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8575, Japan
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Late rescue of proximal endograft failure using fenestrated and branched devices. J Vasc Surg 2014; 59:1479-87. [PMID: 24486036 DOI: 10.1016/j.jvs.2013.12.028] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2013] [Revised: 12/10/2013] [Accepted: 12/10/2013] [Indexed: 11/23/2022]
Abstract
OBJECTIVE Endovascular aneurysm repair (EVAR) will fail over time in a percentage of patients. Mechanical failure of the device, progression of aortic disease, or interface complications between the device and the native vasculature may contribute. Our aim was to evaluate the role of fenestrated and branched endografts as treatment options for failed devices. METHODS Between January 2001 and June 2013, 970 patients were enrolled into a physician-sponsored investigational device exemption (PSIDE) study and treated with a fenestrated/branched endograft. All patients treated for nonurgent proximal neck failure of an infrarenal endoprosthesis previously implanted during EVAR comprised the study group. Patients treated for a primary aneurysm within the PSIDE were evaluated as a comparison group to identify preoperative risk factors for failure. A retrospective review was undertaken to determine the details of the initial EVAR, whereas the prospective PSIDE database was used to assess outcomes of secondary treatment. Three-dimensional imaging techniques were used to define all morphologic measurements. Statistical analysis included comparisons between categoric variables with the χ(2) test and between continuous variables with the Wilcoxon rank sum test between patients with late failures and those with native aortic repair. Kaplan-Meier curves were used to analyze overall survival. RESULTS Of 970 patients enrolled in the PSIDE, 54 (5.6%) had late failure of a prior endograft. Fenestrated/branched devices were used to address the failure in each patient. The etiology of failure was related to a proximal neck issue in all patients: type Ia endoleak in 38, stent migration in 18, neck degeneration in 28, or some combination of these factors. The endovascular rescue procedure took place a mean of 61 months after the primary procedure. The mean aneurysm diameter at reintervention was 67 mm. Patients requiring a secondary fenestrated procedure were younger at the time of their primary intervention (P = .039) and were more likely to have a history of chronic renal insufficiency (P = .05) compared with other patients in the PSIDE. Technical success rate in the study group was 85% (44 of 52). Successful stenting was achieved in 71 of 77 (92%) target vessels. Thirty-day mortality was 3.8% (two of 52). Fluoroscopy dose and operating time were longer in the rescue group (P = .07) than in the control group (P = .008). Secondary interventions were required in 36.5% (19 of 52) of patients. CONCLUSIONS Our series demonstrates the risk for late failure after EVAR is greater in patients who are younger and have chronic renal impairment at the time of implantation. Branched and fenestrated repair after failed EVAR is more complex than repair in the native aorta. More research is needed to identify patients at higher risk of failure after EVAR to prevent the need for rescue in the future.
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Kokot M, Biolik G, Ziaja D, Fojt T, Cisak K, Antoniak K, Pawlicki K, Ziaja K, Duława J. Endothelium injury and inflammatory state during abdominal aortic aneurysm surgery: scrutinizing the very early and minute injurious effects using endothelial markers - a pilot study. Arch Med Sci 2013; 9:479-86. [PMID: 23847670 PMCID: PMC3701970 DOI: 10.5114/aoms.2013.34412] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2012] [Revised: 06/28/2012] [Accepted: 10/18/2012] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION One of the most severe complications of repair surgery for abdominal aortic aneurysms (AAA) is acute kidney injury (AKI). Acute kidney injury is an inflammatory process whose pathogenesis involves endothelial cells (EC). The aim of this study was to assess the dynamics of endothelium injury markers measured during elective AAA surgery which might confirm the inflammatory character of AKI. MATERIAL AND METHODS The study group consisted of 14 patients with AAA. We measured plasma soluble forms of intercellular adhesion molecule-1 (ICAM-1), vascular cell adhesion molecule-1 (VCAM-1), E-selectin, P-selectin as well as the levels of von Willebrand factor (vWF) before, during (including intra-abdominal vein levels before and after aortic clamp removal) and within 2 days after surgery. RESULTS We have found a biphasic response of ICAM-1, VCAM-1 and P-selectin with an initial fall and subsequent rise. However, only VCAM-1 changes were significant compared to its baseline value. The maximum decrease of VCAM-1 was observed in the renal vein 5 min after aortic clamp removal (335.42 ±129.63 ng/ml vs. 488.90 ±169.80 ng/ml baseline value, p < 0.05), and the highest rise 48 h after aortic clamp removal (721.46 ±333.99 vs. baseline, p < 0.05). CONCLUSIONS Vascular cell adhesion molecule-1 turned out to be the most sensitive indicator of EC injury and inflammatory status after AAA surgery. During AAA surgery, soluble forms of P-selectin, ICAM-1 and VCAM-1 demonstrate a biphasic response with an initial fall and subsequent rise. These soluble forms could have a modulatory effect on the development of inflammation.
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Affiliation(s)
- Michał Kokot
- Department of Internal Medicine and Metabolic Diseases, Medical University of Silesia, Katowice, Poland
| | - Grzegorz Biolik
- Department of General and Vascular Surgery, Medical University of Silesia, Katowice, Poland
| | - Damian Ziaja
- Department of General and Vascular Surgery, Medical University of Silesia, Katowice, Poland
| | - Tadeusz Fojt
- Department of Internal Medicine and Metabolic Diseases, Medical University of Silesia, Katowice, Poland
| | - Kamila Cisak
- Department of Internal Medicine and Metabolic Diseases, Medical University of Silesia, Katowice, Poland
| | - Katarzyna Antoniak
- Department of Internal Medicine and Metabolic Diseases, Medical University of Silesia, Katowice, Poland
| | - Krzysztof Pawlicki
- Department of Biophysics, Medical University of Silesia, Katowice, Poland
| | - Krzysztof Ziaja
- Department of General and Vascular Surgery, Medical University of Silesia, Katowice, Poland
| | - Jan Duława
- Department of Internal Medicine and Metabolic Diseases, Medical University of Silesia, Katowice, Poland
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Brooks CE, Middleton A, Dhillon R, Scott D, Denton M. Predictors of creatinine rise post-endovascular abdominal aortic aneurysm repair. ANZ J Surg 2012; 81:827-30. [PMID: 22295426 DOI: 10.1111/j.1445-2197.2011.05699.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Endovascular abdominal aortic aneurysm repair involves manipulation of the aorta around the renal arteries. Fenestrated grafts involve the direct cannulation, stenting and injecting of contrast into the renal arteries. These procedures may be associated with an acute post-operative creatinine rise. METHODS We retrospectively examined data from all endovascular aortic repairs at our institution from 2005 to 2009, where contrast dosage had been recorded. Renal impairment was defined as a 25% increase in creatinine during the 5-day postoperative period. Univariable analysis was undertaken for a number of likely predictors, including: age, contrast dosage, preoperative creatinine, graft type (fenestrated or standard), diabetes mellitus, hypertension, hypercholesterolaemia, ischaemic heart disease, aspirin therapy, statins therapy, non-steroidal anti-inflammatory drug use, preoperative N-acetyl-cysteine and intravenous pre-hydration. Multivariable analysis was then applied to variables with a univariable P-value of < 0.05. RESULTS We identified 106 consecutive cases, with complete data for 102. Twenty per cent of patients developed renal impairment (22/102). Contrast dose (P = 0.043) and fenestrated grafts (P = 0.006) were identified as significant risk factors for post-operative creatinine increase (P = 0.043). Multivariable analysis demonstrated that fenestrated grafts were a risk factor independent of contrast dosage (P < 0.05). CONCLUSIONS Patients who received a fenestration graft (P < 0.01) and increased contrast dose (P < 0.05) were at a significant increased risk of a 25% post-operative creatinine rise. The risk of fenestration grafts persisted when multivariable regression was performed to control for contrast dosage (P < 0.05). Other variables investigated were not found to be significant in this study.
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Álvarez Marcos F, Zanabili Al-Sibbai A, Gutiérrez Julián J, Llaneza Coto J, García de la Torre A, Valle González A. El deterioro renal postoperatorio puede ser útil para predecir el resultado y la supervivencia de la reparación de aneurismas de aorta abdominal, tanto abierta como endovascular. ANGIOLOGIA 2010. [DOI: 10.1016/s0003-3170(10)70050-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Andritsos M, Desai ND, Grewal A, Augoustides JG. Innovations in Aortic Disease Management: The Descending Aorta. J Cardiothorac Vasc Anesth 2010; 24:523-9. [DOI: 10.1053/j.jvca.2010.02.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2010] [Indexed: 11/11/2022]
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LeMaire SA, Jones MM, Conklin LD, Carter SA, Criddell MD, Wang XL, Raskin SA, Coselli JS. Randomized comparison of cold blood and cold crystalloid renal perfusion for renal protection during thoracoabdominal aortic aneurysm repair. J Vasc Surg 2009; 49:11-9; discussion 19. [DOI: 10.1016/j.jvs.2008.08.048] [Citation(s) in RCA: 119] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2008] [Revised: 08/11/2008] [Accepted: 08/19/2008] [Indexed: 11/24/2022]
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Meier P, Haesler E, Teta D, Qanadli SD, Burnier M. [Atherosclerotic renal artery disease management update]. Nephrol Ther 2008; 5:13-24. [PMID: 18815087 DOI: 10.1016/j.nephro.2008.02.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2007] [Revised: 02/13/2008] [Accepted: 02/14/2008] [Indexed: 10/21/2022]
Abstract
In the case of atherosclerotic renal artery disease, the best conclusive results lie principally not in the degree of the stenosis but rather in the degree the renal parenchymal disease beyond the stenosis itself. These determining factors involve the controlling of the patients blood pressure, the improvement in the renal function and the beneficial results to the cardiovascular system. Besides the indispensable medical treatment, a revascularisation by angioplasty may be indicated. This procedure with or without vascular stent often allows satisfactory angiographic results. A treatment by surgical revascularisation is only recommended in the case of extensive atherosclerotic lesions of the aorta, complex lesions of the latter or an abdominal aortic aneurism. Although the frequency of restenosis of angioplasty with stent remains extremely low, the risk of cholesterol emboli due to the diffuse atherosclerotic lesions of the abdominal aorta, must be considered at the time of each aortic catheterization. The therapeutic approach of atherosclerotic renal artery disease must be dictated by the whole cardiovascular risk factors and by the threat of target organs. The control of the blood pressure and the maintenance of the renal function must be integrated in the decisional algorithm as well as the possible risks in carrying out an eventual revascularisation procedure. Finally, the renal angioplasty should in numerous situations be integrated in the overall assumption of responsibility of the atherosclerotic vascular diseases, and should be part of the medical treatment. Several questions still do exist; at what moment an atherosclerotic renal artery stenosis should and e considered critical, and which procedure should be considered for which patient? The purpose of this review is to propose a decisional tool for individualized treatments in the light of results from randomized and controlled studies.
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Affiliation(s)
- Pascal Meier
- Service de néphrologie et hypertension, centre hospitalier universitaire Vaudois, université de Lausanne, rue du Bugnon, 1011 Lausanne, Suisse.
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Pichlmaier M, Hoy L, Wilhelmi M, Khaladj N, Haverich A, Teebken OE. Renal perfusion with venous blood extends the permissible suprarenal clamp time in abdominal aortic surgery. J Vasc Surg 2008; 47:1134-40. [DOI: 10.1016/j.jvs.2008.01.020] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2007] [Revised: 12/31/2007] [Accepted: 01/07/2008] [Indexed: 11/29/2022]
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Turner S, Derham C, Orsi NM, Bosomworth M, Bellamy MC, Howell SJ. Randomized clinical trial of the effects of methylprednisolone on renal function after major vascular surgery. Br J Surg 2008; 95:50-6. [PMID: 18027383 DOI: 10.1002/bjs.5978] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Perioperative renal dysfunction following abdominal aortic aneurysm (AAA) repair is multifactorial and may involve hypotension, hypoxia and ischaemia-reperfusion injury. Studies of cardiac and hepatic transplant surgery have demonstrated beneficial effects on renal function of high-dose methylprednisolone administered before surgery. METHODS Twenty patients undergoing elective open AAA repair were randomized to receive either methylprednisolone 10 mg/kg or dextrose (control) before induction of anaesthesia. Blood was analysed for a panel of cytokines representative of T helper cell type 1 and 2 subsets. Urine was analysed for subclinical markers of renal dysfunction (albumin, alpha(1)-microglobulin and N-acetyl-beta-D-glucosaminidase). RESULTS Data from 18 patients were analysed. Both groups demonstrated glomerular and proximal convoluted tubular dysfunction that was unaffected by steroid treatment. Steroid administration increased serum levels of urea and creatinine (both P < 0.001). The steroid group had increased interleukin 10 levels (P = 0.005 compared to controls). There were no differences between groups in overall surgical complications, length of intensive care unit (P = 0.821) and hospital (P = 0.719) stay, or 30-day mortality. CONCLUSION Methylprednisolone administration altered the cytokine profile favourably but adversely affected postoperative renal function.
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Affiliation(s)
- S Turner
- Academic Unit of Anaesthesia, Leeds General Infirmary, Leeds, UK
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