Abdominal aortic aneurysm

Extravertebral low back pain: a scoping review

BACKGROUND

Low back pain (LBP) is one of the most common reasons for consultation in general practice. Currently, LBP is categorised into specific and non-specific causes. However, extravertebral causes, such as abdominal aortic aneurysm or pancreatitis, are not being considered.

METHODS

A systematic literature search was performed across MEDLINE, Embase, and the Cochrane library, complemented by a handsearch. Studies conducted between 1 January 2001 and 31 December 2020, where LBP was the main symptom, were included.

RESULTS

The literature search identified 6040 studies, from which duplicates were removed, leaving 4105 studies for title and abstract screening. Subsequently, 265 publications were selected for inclusion, with an additional 197 publications identified through the handsearch. The majority of the studies were case reports and case series, predominantly originating from specialised care settings. A clear distinction between vertebral or rare causes of LBP was not always possible. A range of diseases were identified as potential extravertebral causes of LBP, encompassing gynaecological, urological, vascular, systemic, and gastrointestinal diseases. Notably, guidelines exhibited inconsistencies in addressing extravertebral causes.

DISCUSSION

Prior to this review, there has been no systematic investigation into extravertebral causes of LBP. Although these causes are rare, the absence of robust and reliable epidemiological data hinders a comprehensive understanding, as well as the lack of standardised protocols, which contributes to a lack of accurate description of indicative symptoms. While there are certain disease-specific characteristics, such as non-mechanical or cyclical LBP, and atypical accompanying symptoms like fever, abdominal pain, or leg swelling, that may suggest extravertebral causes, it is important to recognise that these features are not universally present in every patient.

CONCLUSION

The differential diagnosis of extravertebral LBP is extensive with relatively low prevalence rates dependent on the clinical setting. Clinicians should maintain a high index of suspicion for extravertebral aetiologies, especially in patients presenting with atypical accompanying symptoms.

CircCBFB-mediated miR-28-5p facilitates abdominal aortic aneurysm via LYPD3 and GRIA4

HEADING AIMS

Abdominal aortic aneurysm (AAA) is featured by the growth impediment and apoptosis surge of VSMCs (vascular smooth muscle cells). MicroRNAs (miRNAs) are suggested to affect cellular behaviors including cell growth and apoptosis. This study concentrated on unraveling the emerging role of miR-28-5p in abdominal aortic aneurysm.

MATERIALS AND METHODS

Previously, miR-28-5p was reported to be highly expressed in AAA. Functional assays were utilized to determine the role of miR-28-5p in VSMC apoptosis. To narrow down the downstream mRNAs, bioinformatics methods were utilized. The interaction between miR-28-5p and GRIA4 (glutamate ionotropic receptor AMPA type subunit 4) or LYPD3 (LY6/PLAUR domain containing 3) was explored. Candidate circRNAs (circular RNAs) of miR-28-5p were identified. Rescue analyses validated function of circCBFB (core-binding factor subunit beta)/miR-28-5p/GRIA4/LYPD3 axis in VSMC apoptosis and growth.

KEY FINDINGS

MiR-28-5p acted as an apoptosis driver while circCBFB, GRIA4 and LYPD3 exerted anti-apoptosis effects in VSMCs. Mechanically, GRIA4 and LYPD3 were suppressed by miR-28-5p. Moreover, circCBFB served as a sponge of miR-28-5p, releasing GRIA4 and LYPD3 from miR-28-5p suppression. Functionally, GRIA4, LYPD3 and miR-28-5p were required in circCBFB-mediated VSMC apoptosis.

SIGNIFICANCE

This work unveiled an innovative axis of circCBFB/miR-28-5p/GRIA4/LYPD3 in VSMC apoptosis, exerting its potential in providing new thoughts in AAA management.

Quality of life among patients with abdominal aortic aneurysm undergoing endografting in Taiwan

BACKGROUND

The use of endovascular aneurysm repair (EVAR) as a treatment for abdominal aortic aneurysm (AAA) has started to become popular in Taiwan. Quality of life is considered an indicator of clinical outcome, and self-management and health literacy have been identified as significant contributors to quality of life. However, the research on these three variables, and relationships among them in AAA patients who have undergone EVAR, is limited.

AIMS

The purpose of this study is to examine the relationship between self-management, health literacy and quality of life in AAA patients who have undergone EVAR in Taiwan.

METHODS

This study uses a cross-sectional design with convenience sampling. A total of 105 patients were sampled in the outpatient clinic when they returned for a follow-up visit to a veterans' general hospital in Taiwan between May 2011 and June 2012. Four questionnaires (demographic, self-management, health literacy, quality of life) were used to collect data. Regarding the relationship among these variables, Pearson correlations and hierarchical logistic regression were used to analyze the relationship.

RESULTS

Self-management has a 73% mediation effect and an indirect effect of 13.51 on the relationship between health literacy and quality of life, while education and exercise habit has a 57% mediation effect and an indirect effect of 6.20 on this same relationship.

CONCLUSION

These findings can be used to identify specific populations who have more risk for worse outcomes. They can then be provided with education to promote exercise behavior and to enhance self-management to achieve better quality of life.

Robust infrarenal aortic aneurysm lumen centerline detection for rupture status classification

The objective of this work is to develop a robust method for human abdominal aortic aneurysm (AAA) centerline detection that can contribute to the accurate computation of features for the prediction of AAA rupture risk. A semiautomatic algorithm is proposed for detecting the lumen centerline in contrast-enhanced abdominal computed tomography images based on online adaboost classifiers, which does not require prior image segmentation. The algorithm was developed and applied to thirty ruptured and thirty unruptured AAA image data sets and the tortuosities of the detected centerline were measured to assess the correlation between AAA tortuosity and the binary ruptured and unruptured labels. The lumen of each data set was segmented manually by a trained radiologist and the resulting centerlines of each data set were defined as the gold standard to evaluate the accuracy of the algorithm and to compare it against two widely used segmentation techniques. The average mean relative accuracy of the offline adaboost classifier is 91.9% with a standard deviation of 1.6%; for the online adaboost classifier it is 93.6% with a standard deviation of 1.9% (p<0.05). The online adaboost classifier outperforms the offline adaboost classifier while their computational costs are similar. Aneurysm tortuosity computed from an accurately derived lumen centerline using online adaboost is statistically higher for ruptured aneurysms compared to unruptured aneurysms, indicating that tortuosity can be used to assess rupture risk in the vascular clinic.

Patients' experience of open repair of abdominal aortic aneurysm--preoperative information, hospital care and recovery

AIMS AND OBJECTIVES

The aim was to elucidate patients' lived experience of the care pathway of going through open surgery for abdominal aortic aneurysm.

BACKGROUND

Open surgical treatment has a great impact on patients' health-related quality of life both before and after treatment. The transition from being independent and asymptomatic to dependent on nursing care can be difficult. To facilitate this process and provide high-quality care, patients' needs must be better understood.

DESIGN

An exploratory descriptive design was chosen to describe and understand patients' lived experience.

METHOD

Audio-taped interviews were performed three months postoperatively, covering the care pathway before and after surgery. Interviews were analysed with qualitative content analysis.

RESULTS

The informants made a transition from becoming aware of the deadly risk associated with abdominal aortic aneurysm to gradually understanding the physical and emotional impact of the surgical procedure during the recovery process. The experience of not understanding fully the risks of undergoing surgery or its consequences on daily life made the informants unprepared for complications and limitations during the recovery period. Many concerns emerged, with a need for more dialogue and opportunities to understand their own care than those provided by the health care staff.

CONCLUSIONS

To facilitate the transition process, health care staff should consider patients' unpreparedness for the physical and emotional impact that can follow diagnosis and treatment for abdominal aortic aneurysm and recognise the need for dialogue to enhance participation during recovery.

RELEVANCE TO CLINICAL PRACTICE

Throughout the care pathway, patients' need for information and for opportunities to reflect on bodily and emotional reactions to the diagnosis and treatment of abdominal aortic aneurysm should be recognised by nurses and physicians to support patients getting realistic expectations of the consequences of treatment and facilitate participation in decisions concerning care and medical treatment.

Abdominal aortic aneurysm presenting as back pain to a chiropractic clinic: a case report

OBJECTIVE

The aim of this study was to discuss a patient with abdominal aortic aneurysm (AAA) who presented to a chiropractic teaching clinic and review the pathophysiology, therapeutic strategies, and complications associated with treatment of AAA.

CLINICAL FEATURES

A 69-year-old male patient experienced right-sided low back pain with radiation into the right leg for 3 weeks. The radiologic examination of the lumbar spine showed a 7.0-cm AAA and degenerative joint disease in the lumbar spine. Real-time ultrasonography showed an approximately 6.0-cm (transverse diameter), 4.1-cm (anteroposterior diameter), and approximately 7.0-cm (long) infrarenal AAA. Computed tomographic angiography showed additional bilateral iliac artery aneurysms.

INTERVENTION AND OUTCOME

This patient was treated with an endovascular stent graft repair of the abdominal aorta and bilateral iliac artery aneurysms. He has done well after surgery.

CONCLUSION

This article provides a case study and an overview of AAA. Rupture of an aortic aneurysm is preventable by cautious surveillance and the recognition of suspicious physical and radiographic findings in the population at risk. Early detection reduces mortality because repair is elective rather than emergent.