1
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Lindenberger M, Ziegler M, Bjarnegård N, Ebbers T, Dyverfeldt P. Regional and Global Aortic Pulse Wave Velocity in Patients with Abdominal Aortic Aneurysm. Eur J Vasc Endovasc Surg 2024; 67:506-513. [PMID: 37777048 DOI: 10.1016/j.ejvs.2023.09.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 07/22/2023] [Accepted: 09/22/2023] [Indexed: 10/02/2023]
Abstract
OBJECTIVE Abdominal aortic aneurysm (AAA) is commonly defined as localised aortic dilatation with a diameter > 30 mm. The pathophysiology of AAA includes chronic inflammation and enzymatic degradation of elastin, possibly increasing aortic wall stiffness and pulse wave velocity (PWV). Whether aortic stiffness is more prominent in the abdominal aorta at the aneurysm site is not elucidated. The aim of this study was to evaluate global and regional aortic PWV in patients with AAA. METHODS Experimental study of local PWV in the thoracic descending and abdominal aorta in patients with AAA and matched controls. The study cohort comprised 25 patients with an AAA > 30 mm (range 36 - 70 mm, all male, age range 65 - 76 years) and 27 age and sex matched controls free of AAA. PWV was measured with applanation tonometry (carotid-femoral PWV, cfPWV) as well as a 4D flow MRI technique, assessing regional aortic PWV. Blood pressure and anthropometrics were measured. RESULTS Global aortic PWV was greater in men with an AAA than controls, both by MRI (AAA 8.9 ± 2.4 m/s vs. controls 7.1 ± 1.5 m/s; p = .007) and cfPWV (AAA 11.0 ± 2.1 m/s vs. controls 9.3 ± 2.3 m/s; p = .007). Regionally, PWV was greater in the abdominal aorta in the AAA group (AAA 7.0 ± 1.8 m/s vs. controls 5.8 ± 1.0 m/s; p = .022), but similar in the thoracic descending aorta (AAA 8.7 ± 3.2 m/s vs. controls 8.2 ± 2.4 m/s; p = .59). Furthermore, PWV was positively associated with indices of central adiposity both in men with AAA and controls. CONCLUSION PWV is higher in men with AAA compared with matched controls in the abdominal but not the thoracic descending aorta. Furthermore, aortic stiffness was linked with central fat deposition. It remains to be seen whether there is a causal link between AAA and increased regional aortic stiffness.
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Affiliation(s)
- Marcus Lindenberger
- Department of Cardiology in Linköping, and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden.
| | - Magnus Ziegler
- Cardiovascular Sciences, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden; Centre for Medical Image Science and Visualisation (CMIV), Linköping University, Linköping, Sweden
| | - Niclas Bjarnegård
- Cardiovascular Sciences, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Tino Ebbers
- Cardiovascular Sciences, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden; Centre for Medical Image Science and Visualisation (CMIV), Linköping University, Linköping, Sweden
| | - Petter Dyverfeldt
- Cardiovascular Sciences, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden; Centre for Medical Image Science and Visualisation (CMIV), Linköping University, Linköping, Sweden
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2
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Rastogi V, Guetter CR, Patel PB, Anjorin AC, Marcaccio CL, Yadavalli SD, Scali ST, Beck AW, Verhagen HJM, Schermerhorn ML. Clinical presentation, outcomes, and threshold for repair by sex in degenerative saccular vs fusiform aneurysms in the descending thoracic aorta. J Vasc Surg 2023; 78:1392-1401.e1. [PMID: 37652142 PMCID: PMC10841204 DOI: 10.1016/j.jvs.2023.06.104] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 06/22/2023] [Accepted: 06/25/2023] [Indexed: 09/02/2023]
Abstract
OBJECTIVE Saccular-shaped thoracic aortic aneurysms (TAAs) are often treated at smaller diameters compared with fusiform TAAs, despite a lack of strong clinical evidence to support this practice. The aim of this study was to examine differences in presentation, treatment, and outcomes between saccular TAAs and fusiform TAAs in the descending thoracic aorta. We also examined the need for sex-specific treatment thresholds for TAAs. METHODS All Vascular Quality Initiative (VQI) patients undergoing thoracic endovascular aneurysm repair (TEVAR) for degenerative TAAs in the descending thoracic aorta from 2012 through 2022 were reviewed. Patients were stratified by urgency: emergent/urgent vs elective repairs (ruptured/symptomatic). Demographics, comorbidities, anatomical/procedural characteristics, and outcomes for fusiform TAAs and saccular TAAs were compared. Cumulative distribution curves were used to plot the proportion of patients who underwent emergent/urgent repair according to sex-stratified aortic diameter. RESULTS Among 655 emergent/urgent TEVARs, 37% were performed for saccular TAAs, whereas among 1352 elective TEVARs, 35% had saccular TAA morphology. Compared with fusiform TAAs, saccular TAAs more frequently underwent emergent/urgent (ruptured/symptomatic) TEVAR below the repair threshold in both females (<50 mm: 38% vs 10%; relative risk, 3.39; 95% confidence interval [CI], 2.04-5.70; P < .001), and males (<55 mm: 47% vs 21%; relative risk, 2.26; 95% CI, 1.60-3.18; P < .001). Moreover, among patients with emergent/urgent fusiform TAAs, females presented at smaller diameters compared with males, whereas there was no difference in preoperative aneurysm diameter among patients with saccular TAAs. Regarding outcomes, emergent/urgent treated saccular TAAs had similar postoperative outcomes and 5-year mortality compared with fusiform TAAs. Nevertheless, in the elective cohort, patients with saccular TAAs had similar postoperative mortality compared with those with fusiform TAAs, but a lower rate of postoperative spinal cord ischemia (0.7% vs 3.2%; P = .010). Furthermore, patients with saccular TAAs had a higher rate of 5-year mortality compared with their fusiform counterparts (23% vs 17%; hazard ratio, 1.53; 95% CI, 1.12-2.10; P = .010). CONCLUSIONS Patients with saccular TAAs underwent emergent/urgent TEVAR at smaller diameters than those with fusiform TAAs, supporting current clinical practice guideline recommendations that saccular TAAs warrant treatment at smaller diameters. Furthermore, these data support a sex-specific treatment threshold for patients with fusiform TAAs, but not for those with saccular TAAs. Although there were no differences in outcomes following TEVAR between morphologies in the emergent/urgent cohort, patients with saccular TAAs who were treated electively were associated with higher 5-year mortality compared with those with fusiform TAAs.
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Affiliation(s)
- Vinamr Rastogi
- Department of Surgery, Division of Vascular and Endovascular Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; Department of Vascular Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Camila R Guetter
- Department of Surgery, Division of Vascular and Endovascular Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Priya B Patel
- Department of Surgery, Division of Vascular and Endovascular Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; Department of General Surgery, Rutgers Robert Wood Johnson University Hospital, New Brunswick, NJ
| | - Aderike C Anjorin
- Department of Surgery, Division of Vascular and Endovascular Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Christina L Marcaccio
- Department of Surgery, Division of Vascular and Endovascular Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Sai Divya Yadavalli
- Department of Surgery, Division of Vascular and Endovascular Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Salvatore T Scali
- Division of Vascular Surgery and Endovascular Therapy, University of Florida, Gainesville, FL
| | - Adam W Beck
- Division of Vascular Surgery and Endovascular Therapy, University of Alabama at Birmingham, Birmingham, AL
| | - Hence J M Verhagen
- Department of Vascular Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Marc L Schermerhorn
- Department of Surgery, Division of Vascular and Endovascular Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA.
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Carlestål E, Thorell A, Bergstrand L, Wilamowski F, Franco-Cereceda A, Olsson C. High Prevalence of Thoracic Aortic Dilatation in Men with Previous Inguinal Hernia Repair. AORTA (STAMFORD, CONN.) 2022; 10:122-130. [PMID: 36318933 PMCID: PMC9626032 DOI: 10.1055/s-0042-1749172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Background
Identifying a useful marker for thoracic aortic dilatation (TAD) could help improve informed clinical decisions, enhance diagnosis, and develop TAD screening programs. Inguinal hernia could be such a marker. This study tested the hypothesis that the thoracic aorta is larger and more often dilated in men with previous inguinal hernia repair versus nonhernia controls.
Methods
Four hundred men each with either previous inguinal hernia repair or cholecystectomy (controls) were identified to undergo chest computed tomography to measure the diameter of the thoracic aorta in the aortic root, ascending, isthmic, and descending aorta and to provide self-reported health data. Presence of TAD (root or ascending diameter > 45 mm; isthmic or descending diameter > 35 mm) and thoracic aortic diameters were compared between groups and associations explored using uni- and multivariable statistical methods.
Results
Complete data were obtained from 470/718 (65%) eligible participants. TAD prevalence was significantly higher in the inguinal hernia group: 21 (10%) versus 6 (2.4%),
p
= 0.001 for proximal TAD, 29 (13%) versus 21 (8.3%),
p
= 0.049 for distal TAD, and 50 (23%) versus 27 (11%),
p
< 0.001 for all aortic segments combined. In multivariable analysis, previous inguinal hernia repair was independently associated with dilatation of the proximal aorta (odds ratio 5.3, 95% confidence interval 1.8–15,
p
= 0.003). Contrarily, mean thoracic aortic diameters were similar (root and ascending aorta) or showed clinically irrelevant differences (isthmus and descending aorta).
Conclusion
TAD, but not increased aortic diameters on average, was common and significantly more prevalent in men with previous inguinal hernia repair. Hernia could be a marker condition associated with increased prevalence of TAD. Ultimately, TAD screening could consider hernia as a possible selection criterion.
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Affiliation(s)
- Emelie Carlestål
- Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden,Department of Cardiothoracic Surgery, Karolinska University Hospital, Karolinska Institute, Stockholm, Sweden
| | - Anders Thorell
- Clinical Sciences at Danderyd Hospital, Karolinska Institute, Stockholm, Sweden,Department of Surgery, Ersta Hospital, Stockholm, Sweden
| | | | | | - Anders Franco-Cereceda
- Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden,Department of Cardiothoracic Surgery, Karolinska University Hospital, Karolinska Institute, Stockholm, Sweden
| | - Christian Olsson
- Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden,Department of Cardiothoracic Surgery, Karolinska University Hospital, Karolinska Institute, Stockholm, Sweden,Address for correspondence Christian Olsson, MD, PhD Department of Cardiothoracic Surgery, Karolinska University HospitalEugeniavägen 23 C12:27, Stockholm SE17176Sweden
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Spinal cord ischemia following simultaneous EVAR and TEVAR for concomitant thoracic and abdominal aortic aneurysms. Ann Vasc Surg 2022; 87:343-350. [PMID: 35926790 DOI: 10.1016/j.avsg.2022.06.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Revised: 06/21/2022] [Accepted: 06/23/2022] [Indexed: 11/24/2022]
Abstract
OBJECTIVES In patients with abdominal aortic aneurysms, 10-20% have concomitant thoracic aortic pathologies. These are typically managed with staged endovascular aneurysm repair (EVAR) and thoracic endovascular aortic repair (TEVAR) due to a perceived higher risk of spinal cord ischemia from a simultaneous intervention. We aimed to determine the outcomes of patients undergoing simultaneous EVAR and TEVAR for concomitant aneurysms. METHODS A retrospective cohort study was performed using the Vascular Quality Initiative registry from December 2003 to January 2021. Patients undergoing same-day EVAR and TEVAR were included and analyzed in accordance with the Society for Vascular Surgery reporting standards. Primary outcomes were technical success and spinal cord ischemia. RESULTS Simultaneous EVAR and TEVAR was performed in 25 patients. Median age was 75.0 (IQR 63.0-79.0) years and 20 (80.0%) patients were male. Two (4.0%) patients were symptomatic and four (16.0%) presented with rupture. Median maximum infrarenal and thoracic aortic diameter was 57.0 (IQR 52.0-65.0). Infrarenal aortic neck length was 15.0mm (IQR 10.0-25.0), and diameter was 27.0mm (IQR 24.5-30.0). Median procedure time was 185.0 minutes (IQR, 117.8-251.3), fluoroscopy time 32.7 minutes (IQR, 21.8-63.1), and contrast volume 165 ml (IQR 115.0-207.0). There were three (12.0%) Type Ia endoleaks and three (12.0%) Type II endoleaks in EVAR's, with one (4.0%) Type Ia and one (4.0%) Type II endoleak in TEVARs. In-hospital mortality occurred in three (12.0%) patients (one elective, two ruptures). Spinal cord ischemia occurred in one (4.0%) patient. This patient had a symptomatic aneurysm. Thoracic coverage extended from Zone 4 to Zone 5 and an emergent spinal drain was placed postoperatively. Symptoms were present on discharge. There was one (4.0%) conversion to open repair which occurred in a ruptured aneurysm. Technical success was achieved in 19 (76.0%) patients, however when excluding ruptured aneurysms, was achieved in 17 (81.0%) patients. Follow-up data was available for 19 (76.0%) patients at a median of 426.0 (IQR 329.0-592.5) days postoperatively. A total of 3 (12.0%) patients died during the late mortality period, at a mean of 509.0 (±503.7) days. Median change in abdominal and thoracic aortic sac diameter was -1.35mm (IQR -11.5-2.5) and 8.0 (IQR -10.5-12.0) respectively. CONCLUSIONS Simultaneous EVAR and TEVAR for concomitant abdominal and thoracic aortic aneurysms can be performed with low rates of spinal cord ischemia. Short- and mid-term outcomes are acceptable.
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5
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Jessula S, Eagleton MJ. Conversion of failed endovascular infrarenal aortic aneurysm repair with fenestrated/branched stent grafts. Semin Vasc Surg 2022; 35:341-349. [DOI: 10.1053/j.semvascsurg.2022.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 06/23/2022] [Accepted: 06/27/2022] [Indexed: 11/11/2022]
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Impact of Female Sex on Outcomes of Patients Undergoing Thoracic Endovascular Aortic Aneurysm Repair: A Ten-Year Retrospective Nationwide Study in France. J Clin Med 2022; 11:jcm11082253. [PMID: 35456346 PMCID: PMC9029404 DOI: 10.3390/jcm11082253] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 04/06/2022] [Accepted: 04/12/2022] [Indexed: 12/04/2022] Open
Abstract
The impact of sex on the outcomes of patients with cardiovascular disease is still incompletely understood. The aim of this nationwide multicenter observational study was to investigate the impact of sex on post-operative outcomes in patients undergoing thoracic endovascular aortic repair (TEVAR) for intact thoracic aortic aneurysm (iTAA). The French National Health Insurance Information System was searched to identify these patients over a ten-year retrospective period. Post-operative outcomes, 30-day and overall mortality were recorded. Among the 7383 patients included (5521 men and 1862 women), females were significantly older than males (66.8 vs. 64.8 years, p < 0.001). They were less frequently diagnosed with cardiovascular comorbidities. Post-operatively, women had less frequently respiratory (10.9 vs. 13.7%, p = 0.002) as well as cardiac complications (34.3 vs. 37.3%, p = 0.023), but they had more frequently arterial complications (52.8 vs. 49.8%, p = 0.024). There was no significant difference on overall mortality for a mean follow-up of 2.2 years (26.9 vs. 27.6%, p = 0.58). In the multivariable regression model, female sex was not associated with 30-day or overall mortality. Although women had a favorable comorbidity profile, the short-term and long-term survival was similar. The significantly higher rate of arterial complications suggests that women may be at higher risk of access-vessel-related complications.
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7
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Patel PB, Marcaccio CL, de Guerre LEVM, Patel VI, Wang G, Giles K, Schermerhorn ML. Complications after thoracic endovascular aortic repair for ruptured thoracic aortic aneurysms remain high compared with elective repair. J Vasc Surg 2022; 75:842-850. [PMID: 34655686 PMCID: PMC8863631 DOI: 10.1016/j.jvs.2021.09.047] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2021] [Accepted: 09/29/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Thoracic endovascular aortic repair (TEVAR) for ruptured thoracic aortic aneurysms is associated with increased perioperative mortality and morbidity compared with intact repair. The purpose of our study was to evaluate the factors associated with the presentation of ruptured aneurysms and adverse outcomes after repair. METHODS The Vascular Quality Initiative (VQI) registry was queried (2010-2020) to identify patients who had undergone TEVAR for ruptured and intact thoracic aortic aneurysms. The primary outcome was to identify the factors associated with ruptured thoracic aortic aneurysms. The secondary outcomes included perioperative mortality and morbidity, 5-year survival, and the identification of factors associated with adverse outcomes after TEVAR. RESULTS Of the 3039 patients identified with a thoracic aortic aneurysm, 2806 (92%) had undergone repair for an intact aneurysm and 233 (8%) had undergone repair for a ruptured aneurysm. Chronic kidney disease was associated with a greater odds of a presentation with a ruptured aneurysm (odds ratio [OR], 3.1; 95% confidence interval [CI], 2.0-4.9; P < .001). The factors associated with a lower odds of rupture included prior aortic aneurysm repair (OR, 0.71; 95% CI, 0.49-0.97; P = .05), prior smoker (OR, 0.36; 95% CI, 0.24-0.53; P < .001), preoperative beta-blocker therapy (OR, 0.57; 95% CI, 0.41-0.80; P = .001), and preoperative statin therapy (OR, 0.68; 95% CI, 0.49-0.94; P = .020). TEVAR for ruptured thoracic aortic aneurysms was associated with higher perioperative mortality (rupture vs intact, 27% vs 4.6%; OR, 6.6; 95% CI 4.3-10; P < .001) and the composite outcome of mortality, new dialysis, paralysis, and stroke (38% vs 9.5%; OR, 5.1; 95% CI, 3.5-7.4; P < .001). The 5-year survival was significantly lower after TEVAR for ruptured thoracic aortic aneurysms (50% vs 76%; P < .001; hazard ratio, 0.39; 95% CI, 0.29-0.52; P < .001). Preoperative statin therapy was associated with higher 5-year survival (hazard ratio, 1.3; 95% CI, 1.0-1.6; P = .021). CONCLUSIONS TEVAR for ruptured thoracic aortic aneurysms results in increased perioperative mortality and morbidity and lower 5-year survival compared with TEVAR for intact aneurysms. Patients with prior aortic aneurysm repair, prior smoking, and preoperative beta-blocker or statin therapy were less likely to present with ruptured thoracic aneurysms. This correlation might be attributed to increased exposure to cardiovascular healthcare providers and, thus, subsequently increased screening and surveillance, allowing for elective repair of thoracic aortic aneurysms.
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Affiliation(s)
- Priya B Patel
- Division of Vascular and Endovascular Surgery, Beth Israel Deaconess Medical Center, Boston, Mass
| | - Christina L Marcaccio
- Division of Vascular and Endovascular Surgery, Beth Israel Deaconess Medical Center, Boston, Mass
| | - Livia E V M de Guerre
- Division of Vascular and Endovascular Surgery, Beth Israel Deaconess Medical Center, Boston, Mass
| | - Virendra I Patel
- Division of Vascular Surgery and Endovascular Interventions, Columbia University Medical Center, New York, NY
| | - Grace Wang
- Division of Vascular and Endovascular Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pa
| | - Kristina Giles
- Division of Vascular and Endovascular Surgery, Maine Medical Center, Portland, Me
| | - Marc L Schermerhorn
- Division of Vascular and Endovascular Surgery, Beth Israel Deaconess Medical Center, Boston, Mass.
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Kalyanasundaram A, Elefteriades J. The Genetics of Inheritable Aortic Diseases. CURRENT CARDIOVASCULAR RISK REPORTS 2022. [DOI: 10.1007/s12170-022-00687-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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9
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Weininger G, Chan SM, Zafar M, Ziganshin BA, Elefteriades JA. Risk reduction and pharmacological strategies to prevent progression of aortic aneurysms. Expert Rev Cardiovasc Ther 2021; 19:619-631. [PMID: 34102944 DOI: 10.1080/14779072.2021.1940958] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
INTRODUCTION While size thresholds exist to determine when aortic aneurysms warrant surgical intervention, there is no consensus on how best to treat this disease before aneurysms reach the threshold for intervention. Since a landmark study in 1994 first suggested ß-blockers may be useful in preventing aortic aneurysm growth, there has been a surge in research investigating different pharmacologic therapies for aortic aneurysms - with very mixed results. AREAS COVERED We have reviewed the existing literature on medical therapies used for thoracic and abdominal aortic aneurysms in humans. These include ß-blockers, angiotensin II receptor blockers, and angiotensin-converting enzyme inhibitors as well as miscellaneous drugs such as tetracyclines, macrolides, statins, and anti-platelet medications. EXPERT OPINION While multiple classes of drugs have been explored for risk reduction in aneurysm disease, with few exceptions results have been disappointing with an abundance of contradictory findings. The vast majority of studies have been done in patients with abdominal aortic aneurysms or thoracic aortic aneurysm patients with Marfan Syndrome. There exists a striking gap in the literature when it comes to pharmacologic management of non-Marfan Syndrome patients with thoracic aortic aneurysms. Given the differences in pathogenesis, this is an important future direction for aortic aneurysm research.
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Affiliation(s)
- Gabe Weininger
- Aortic Institute at Yale-New Haven Hospital, Yale University School of Medicine, New Haven, CT, USA
| | - Shin Mei Chan
- Aortic Institute at Yale-New Haven Hospital, Yale University School of Medicine, New Haven, CT, USA
| | - Mohammad Zafar
- Aortic Institute at Yale-New Haven Hospital, Yale University School of Medicine, New Haven, CT, USA
| | - Bulat A Ziganshin
- Aortic Institute at Yale-New Haven Hospital, Yale University School of Medicine, New Haven, CT, USA
| | - John A Elefteriades
- Aortic Institute at Yale-New Haven Hospital, Yale University School of Medicine, New Haven, CT, USA
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10
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Gaudry M, Barral PA, Blanchard A, Palazzolo S, Bolomey S, Omnes V, De Masi M, Carcopino-Tusoli M, Meyrignac O, Rousseau H, Jacquier A, Hassen-Khodja R, Bura-Rivière A, Bartoli JM, Gentile S, Piquet P, Bal L. Prevalence of Thoracic Aortic Aneurysms in Patients with Degenerative Abdominal Aortic Aneurysms: Results from the Prospective ACTA Study. Eur J Vasc Endovasc Surg 2021; 61:930-937. [PMID: 33892987 DOI: 10.1016/j.ejvs.2021.03.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 02/10/2021] [Accepted: 03/02/2021] [Indexed: 01/16/2023]
Abstract
OBJECTIVE There are no recommendations for screening for thoracic aortic aneurysms (TAAs), even in patients with infrarenal abdominal aortic aneurysms (AAAs). The aims of this study were to determine the prevalence of TAAs in patients with AAAs and to analyse the risk factors for this association. METHODS This was a multicentre prospective study. The Aortic Concomitant Thoracic and Abdominal Aneurysm (ACTA) study included 331 patients with infrarenal AAAs > 40 mm between September 2012 and May 2016. These patients were prospectively enrolled in three French academic hospitals. RESULTS Patients were classified as having a normal, aneurysmal, or ectatic (non-normal, non-aneurysmal) thoracic aorta according to their maximum aortic diameter indexed by sex, age, and body surface area. Thoracic aortic ectasia (TAE) was defined as above or equal to the 90th percentile of normal aortic diameters according to gender and body surface area. Descending TAA was defined as ≥ 150% of the mean normal value, and ascending TAA as > 47 mm in men and 42 mm in women; 7.6% (n = 25) had either an ascending (seven cases; 2.2%) or descending aortic TAA (18 cases; 5.4%), and 54.6% (n = 181) had a TAE. Among the 25 patients with TAAs, five required surgery; two patients had TAAs related to penetrating aortic ulcers < 60 mm in diameter, and three had a TAA > 60 mm. In the multinomial regression analysis, atrial fibrillation (AF) (odds ratio [OR] 11.36, 95% confidence interval [CI] 2.18 - 59.13; p = .004) and mild aortic valvulopathy (OR 2.89, 1.04-8.05; p = .042) were independent factors associated with TAAs. Age (OR 1.06, CI 1.02 - 1.09; p = .003) and AF (OR 4.36, 1.21 - 15.61; p = .024) were independently associated with ectasia. CONCLUSION This study confirmed that TAAs coexisting with AAAs are not rare, and one fifth of these TAAs are treated surgically. Systematic screening by imaging the whole aorta in patients with AAAs is clinically relevant and should lead to an effective prevention policy.
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Affiliation(s)
- Marine Gaudry
- Department of Vascular Surgery, APHM, Timone Hospital, Marseille, France; Aortic Centre, APHM, Timone Hospital, Marseille, France.
| | - Pierre-Antoine Barral
- Department of Radiology, APHM, Timone Hospital, Marseille, France; Aortic Centre, APHM, Timone Hospital, Marseille, France
| | | | | | - Sonia Bolomey
- Department of Vascular Surgery, APHM, Timone Hospital, Marseille, France; Aortic Centre, APHM, Timone Hospital, Marseille, France
| | - Virgile Omnes
- Department of Vascular Surgery, APHM, Timone Hospital, Marseille, France; Aortic Centre, APHM, Timone Hospital, Marseille, France
| | - Mariangela De Masi
- Department of Vascular Surgery, APHM, Timone Hospital, Marseille, France; Aortic Centre, APHM, Timone Hospital, Marseille, France
| | - Magali Carcopino-Tusoli
- Department of Vascular Surgery, APHM, Timone Hospital, Marseille, France; Aortic Centre, APHM, Timone Hospital, Marseille, France
| | - Olivier Meyrignac
- Department of Radiology, University Hospital of Toulouse, Toulouse, France
| | - Hervé Rousseau
- Department of Radiology, University Hospital of Toulouse, Toulouse, France
| | - Alexis Jacquier
- Department of Radiology, APHM, Timone Hospital, Marseille, France; Aortic Centre, APHM, Timone Hospital, Marseille, France
| | - Reda Hassen-Khodja
- Department of Vascular Surgery, University Hospital of Nice, Hôpital Pasteur, Nice, France
| | | | - Jean-Michel Bartoli
- Department of Radiology, APHM, Timone Hospital, Marseille, France; Aortic Centre, APHM, Timone Hospital, Marseille, France
| | - Stéphanie Gentile
- Department of Medical Evaluation, EA 3279 CEReSS, AP-HM, Conception Hospital, Marseille, France
| | - Philippe Piquet
- Department of Vascular Surgery, APHM, Timone Hospital, Marseille, France; Aortic Centre, APHM, Timone Hospital, Marseille, France
| | - Laurence Bal
- Department of Vascular Surgery, APHM, Timone Hospital, Marseille, France; Aortic Centre, APHM, Timone Hospital, Marseille, France.
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11
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Abstract
Thoracoabdominal aortic aneurysms, although rare, continue to be associated with high morbidity and mortality in the modern era of vascular surgery, and knowledge of this disease is essential for those in clinical practice. Given the clinically silent nature of the disease, it is difficult to determine disease incidence, with most epidemiologic recommendations not made based on evidence regarding those diagnosed with the disease, but extrapolated from data on surgical outcomes. It appears that although men are more likely to develop thoracoabdominal aortic aneurysms, the distribution is not as skewed as in abdominal aortic aneurysms. Current evidence suggests that Black and Hispanic patients continue to have disproportionately poor disease outcomes, mostly attributed to later presentation and undergoing interventions at lower-volume centers. Although select patients meet criteria for disease screening based on personal or family history of aneurysmal disease, general population screening has not been recommended by any professional organization to date. Vascular surgeons need to continue to be at the forefront of thoracoabdominal aortic aneurysm management, especially as care becomes centered around comprehensive "aortic care centers" and as more endovascular therapies become available.
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Affiliation(s)
- Jordan B Stoecker
- Department of Surgery, Hospital of the University of Pennsylvania, 3400 Spruce Street, Maloney 4th Floor, Philadelphia, PA 19104.
| | - Grace J Wang
- Division of Vascular Surgery and Endovascular Therapy, Hospital of the University of Pennsylvania, 3400 Spruce Street, Maloney 4th Floor, Philadelphia, PA 19104.
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12
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Bi S, Liu R, He L, Li J, Gu J. Bioinformatics analysis of common key genes and pathways of intracranial, abdominal, and thoracic aneurysms. BMC Cardiovasc Disord 2021; 21:14. [PMID: 33407182 PMCID: PMC7788746 DOI: 10.1186/s12872-020-01838-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Accepted: 12/18/2020] [Indexed: 02/08/2023] Open
Abstract
Background Aneurysm is a severe and fatal disease. This study aims to comprehensively identify the highly conservative co-expression modules and hub genes in the abdominal aortic aneurysm (AAA), thoracic aortic aneurysm (TAA) and intracranial aneurysm (ICA) and facilitate the discovery of pathogenesis for aneurysm. Methods GSE57691, GSE122897, and GSE5180 microarray datasets were downloaded from the Gene Expression Omnibus database. We selected highly conservative modules using weighted gene co‑expression network analysis before performing the Gene Ontology, Kyoto Encyclopedia of Genes and Genomes pathway and Reactome enrichment analysis. The protein–protein interaction (PPI) network and the miRNA-hub genes network were constructed. Furtherly, we validated the preservation of hub genes in three other datasets. Results Two modules with 193 genes and 159 genes were identified as well preserved in AAA, TAA, and ICA. The enrichment analysis identified that these genes were involved in several biological processes such as positive regulation of cytosolic calcium ion concentration, hemostasis, and regulation of secretion by cells. Ten highly connected PPI networks were constructed, and 55 hub genes were identified. In the miRNA-hub genes network, CCR7 was the most connected gene, followed by TNF and CXCR4. The most connected miRNAs were hsa-mir-26b-5p and hsa-mir-335-5p. The hub gene module was proved to be preserved in all three datasets. Conclusions Our study highlighted and validated two highly conservative co-expression modules and miRNA-hub genes network in three kinds of aneurysms, which may promote understanding of the aneurysm and provide potential therapeutic targets and biomarkers of aneurysm.
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Affiliation(s)
- Siwei Bi
- West China School of Medicine, Sichuan University, Chengdu, Sichuan, People's Republic of China
| | - Ruiqi Liu
- Department of Burn and Plastic Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China
| | - Linfeng He
- West China School of Medicine, Sichuan University, Chengdu, Sichuan, People's Republic of China
| | - Jingyi Li
- West China School of Medicine, Sichuan University, Chengdu, Sichuan, People's Republic of China
| | - Jun Gu
- Department of Cardiovascular Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China.
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13
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Gouveia E Melo R, Silva Duarte G, Lopes A, Alves M, Caldeira D, Fernandes E Fernandes R, Mendes Pedro L. Synchronous and Metachronous Thoracic Aortic Aneurysms in Patients With Abdominal Aortic Aneurysms: A Systematic Review and Meta-Analysis. J Am Heart Assoc 2020; 9:e017468. [PMID: 33103575 PMCID: PMC7763396 DOI: 10.1161/jaha.120.017468] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background The prevalence of thoracic aortic aneurysms (TAA) in patients with known abdominal aortic aneurysms (AAA) is not well known and understudied. Our aim was to conduct a systematic review and meta-analysis of the overall prevalence of synchronous and metachronous TAA (SM-TAA) in patients with a known AAA and to understand the characteristics of this sub-population. Methods and Results We searched MEDLINE, EMBASE, and CENTRAL (Cochrane Central Register of Controlled Trials) from inception to November 2019 for all population-based studies reporting on the prevalence of SM-TAAs in a cohort of patients with AAA. Article screening and data extraction were performed by 2 authors and data were pooled using a random-effects model of proportions using Freeman-Tukey double arcsine transformation. The main outcome was the prevalence of SM-TAAs in patients with AAAs. Secondary outcomes were the prevalence of synchronous TAAs, metachronous TAAs, prevalence of TAAs in patients with AAA according to the anatomic location (ascending, arch, and descending) and the differences in prevalence of these aneurysms according to sex and risk factors. Six studies were included. The pooled-prevalence of SM-TAA in AAA patients was 19.2% (95% CI, 12.3-27.3). Results revealed that 15.2% (95% CI, 7.1-25.6) of men and 30.7% (95% CI, 25.2-36.5) of women with AAA had an SM-TAA. Women with AAA had a 2-fold increased risk of having an SM-TAA than men (relative risk [RRs], 2.16; 95% CI, 1.32-3.55). Diabetes mellitus was associated with a 43% decreased risk of having SM-TAA (RRs, 0.57; 95% CI, 0.41-0.80). Conclusions Since a fifth of AAA patients will have an SM-TAA, routine screening of SM-TAA and their clinical impact should be more thoroughly studied in patients with known AAA.
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Affiliation(s)
- Ryan Gouveia E Melo
- Vascular Surgery Department Hospital Santa Maria Centro Hospitalar Universitário Lisboa Norte (CHULN) Lisboa Portugal.,Faculty of Medicine University of Lisbon Lisboa Portugal.,Cardiovascular Center of the University of Lisbon (CCUL) Lisboa Portugal
| | - Gonçalo Silva Duarte
- Faculty of Medicine University of Lisbon Lisboa Portugal.,Laboratory of Clinical Pharmacology and Therapeutics Faculty of Medicine University of Lisbon Lisboa Portugal.,Instituto de Medicina Molecular Faculty of Medicine University of Lisbon Lisboa Portugal
| | - Alice Lopes
- Vascular Surgery Department Hospital Santa Maria Centro Hospitalar Universitário Lisboa Norte (CHULN) Lisboa Portugal.,Cardiovascular Center of the University of Lisbon (CCUL) Lisboa Portugal
| | - Mariana Alves
- Faculty of Medicine University of Lisbon Lisboa Portugal.,Laboratory of Clinical Pharmacology and Therapeutics Faculty of Medicine University of Lisbon Lisboa Portugal.,Instituto de Medicina Molecular Faculty of Medicine University of Lisbon Lisboa Portugal.,Serviço de Medicina III Hospital Pulido Valente (CHULN) Lisboa Portugal
| | - Daniel Caldeira
- Faculty of Medicine University of Lisbon Lisboa Portugal.,Cardiovascular Center of the University of Lisbon (CCUL) Lisboa Portugal.,Laboratory of Clinical Pharmacology and Therapeutics Faculty of Medicine University of Lisbon Lisboa Portugal.,Instituto de Medicina Molecular Faculty of Medicine University of Lisbon Lisboa Portugal.,Serviço de Cardiologia Hospital Universitário de Santa Maria (CHULN) Lisboa Portugal
| | - Ruy Fernandes E Fernandes
- Vascular Surgery Department Hospital Santa Maria Centro Hospitalar Universitário Lisboa Norte (CHULN) Lisboa Portugal.,Faculty of Medicine University of Lisbon Lisboa Portugal.,Cardiovascular Center of the University of Lisbon (CCUL) Lisboa Portugal
| | - Luís Mendes Pedro
- Vascular Surgery Department Hospital Santa Maria Centro Hospitalar Universitário Lisboa Norte (CHULN) Lisboa Portugal.,Faculty of Medicine University of Lisbon Lisboa Portugal.,Cardiovascular Center of the University of Lisbon (CCUL) Lisboa Portugal
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14
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Dombrowski D, Long GW, Chan J, Brown OW. Screening Chest Computed Tomography is Indicated in All Patients with Abdominal Aortic Aneurysm. Ann Vasc Surg 2020; 65:190-195. [DOI: 10.1016/j.avsg.2019.11.029] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2019] [Revised: 11/18/2019] [Accepted: 11/19/2019] [Indexed: 10/25/2022]
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15
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Abstract
Dissections or ruptures of aortic aneurysms remain a leading cause of death in the developed world, with the majority of deaths being preventable if individuals at risk are identified and properly managed. Genetic variants predispose individuals to these aortic diseases. In the case of thoracic aortic aneurysm and dissections (thoracic aortic disease), genetic data can be used to identify some at-risk individuals and dictate management of the associated vascular disease. For abdominal aortic aneurysms, genetic associations have been identified, which provide insight on the molecular pathogenesis but cannot be used clinically yet to identify individuals at risk for abdominal aortic aneurysms. This compendium will discuss our current understanding of the genetic basis of thoracic aortic disease and abdominal aortic aneurysm disease. Although both diseases share several pathogenic similarities, including proteolytic elastic tissue degeneration and smooth muscle dysfunction, they also have several distinct differences, including population prevalence and modes of inheritance.
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Affiliation(s)
- Amélie Pinard
- From the Division of Medical Genetics, Department of Internal Medicine, McGovern Medical School; University of Texas Health Science Center at Houston (A.P., D.M.M.)
| | - Gregory T Jones
- Department of Surgical Sciences, Dunedin School of Medicine, University of Otago, New Zealand (G.T.J.)
| | - Dianna M Milewicz
- From the Division of Medical Genetics, Department of Internal Medicine, McGovern Medical School; University of Texas Health Science Center at Houston (A.P., D.M.M.)
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16
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Brownstein AJ, Bin Mahmood SU, Saeyeldin A, Velasquez Mejia C, Zafar MA, Li Y, Rizzo JA, Dahl NK, Erben Y, Ziganshin BA, Elefteriades JA. Simple renal cysts and bovine aortic arch: markers for aortic disease. Open Heart 2019; 6:e000862. [PMID: 30774963 PMCID: PMC6350752 DOI: 10.1136/openhrt-2018-000862] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Revised: 06/26/2018] [Accepted: 07/03/2018] [Indexed: 12/03/2022] Open
Abstract
Objective This study aimed to assess the prevalence of thoracic aortic disease (TAD) and abdominal aortic aneurysms (AAA) among patients with simple renal cyst (SRC) and bovine aortic arch (BAA). Methods Through a retrospective search for patients who underwent both chest and abdominal CT imaging at our institution from 2012 to 2016, we identified patients with SRC and BAA and propensity score matched them to those without these features by age, gender and presence of hypertension, hyperlipidaemia, diabetes and chronic kidney disease. Results Of a total of 35 498 patients, 6366 were found to have SRC. Compared with the matched population without SRC, individuals with SRC were significantly more likely to have TAD (10.1% vs 3.9%), ascending aortic aneurysm (8.0% vs 3.2%), descending aortic aneurysm (3.3% vs 0.9%), type A aortic dissection (0.6% vs 0.2%), type B aortic dissection (1.1% vs 0.3%) and AAA (7.9% vs 3.3%). The 920 patients identified with BAA were significantly more likely to have TAD (21.8% vs 4.5%), ascending aortic aneurysm (18.4% vs 3.2%), descending aortic aneurysm (6.5% vs 2.0%), type A aortic dissection (1.4% vs 0.4%) and type B aortic dissection (2.4% vs 0.7%) than the matched population without BAA. SRC and BAA were found to be significantly associated with the presence of TAD (OR=2.57 and 7.69, respectively) and AAA (OR=2.81 and 2.56, respectively) on multivariable analysis. Conclusions This study establishes a substantial increased prevalence of aortic disease among patients with SRC and BAA. SRC and BAA should be considered markers for aortic aneurysm development.
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Affiliation(s)
- Adam J Brownstein
- Aortic Institute at Yale-New Haven Hospital, Yale School of Medicine, New Haven, Connecticut, USA.,Department of Medicine, Johns Hopkins Hospital and Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Syed Usman Bin Mahmood
- Aortic Institute at Yale-New Haven Hospital, Yale School of Medicine, New Haven, Connecticut, USA
| | - Ayman Saeyeldin
- Aortic Institute at Yale-New Haven Hospital, Yale School of Medicine, New Haven, Connecticut, USA
| | - Camilo Velasquez Mejia
- Aortic Institute at Yale-New Haven Hospital, Yale School of Medicine, New Haven, Connecticut, USA
| | - Mohammad A Zafar
- Aortic Institute at Yale-New Haven Hospital, Yale School of Medicine, New Haven, Connecticut, USA
| | - Yupeng Li
- Department of Political Science and Economics, Rowan University, Glassboro, New Jersey, USA
| | - John A Rizzo
- Aortic Institute at Yale-New Haven Hospital, Yale School of Medicine, New Haven, Connecticut, USA.,Department of Economics, Stony Brook University, Stony Brook, New York, USA.,Department of Family, Population and Preventive Medicine, Stony Brook University, Stony Brook, New York, USA
| | - Neera K Dahl
- Section of Nephrology, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Young Erben
- Aortic Institute at Yale-New Haven Hospital, Yale School of Medicine, New Haven, Connecticut, USA.,Section of Vascular and Endovascular Surgery, Yale School of Medicine, New Haven, Connecticut, USA
| | - Bulat A Ziganshin
- Aortic Institute at Yale-New Haven Hospital, Yale School of Medicine, New Haven, Connecticut, USA.,Department of Surgical Diseases No 2, Kazan State Medical University, Kazan, Russia
| | - John A Elefteriades
- Aortic Institute at Yale-New Haven Hospital, Yale School of Medicine, New Haven, Connecticut, USA
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17
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Wallinder J, Georgiou A, Wanhainen A, Björck M. Prevalence of Synchronous and Metachronous Aneurysms in Women With Abdominal Aortic Aneurysm. Eur J Vasc Endovasc Surg 2018; 56:435-440. [PMID: 29935861 DOI: 10.1016/j.ejvs.2018.05.015] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Accepted: 05/16/2018] [Indexed: 01/08/2023]
Abstract
BACKGROUND Abdominal aortic aneurysm (AAA) is three to five times more common among men compared with women, yet up to 38% of all aneurysm related deaths affect women. The aim of this study was to estimate the prevalence of synchronous or metachronous aneurysms among women with AAA, as diagnosis and treatment could improve survival. PATIENTS AND METHODS This is a retrospective study of prospectively registered patients. All women operated on, or under surveillance for, AAA were identified at two Swedish hospitals. Aneurysms in different locations were identified using available imaging studies. Aneurysms were defined according to location: thoracic ascending aorta ≥42 mm, descending ≥33 mm, abdominal aorta ≥30 mm, common iliac artery ≥20 mm or 50% wider than the contralateral artery, common femoral artery ≥12 mm, popliteal artery ≥10 mm. RESULTS A total of 339 women with an AAA were included. The median follow up was 2.8 (range 0-15.7) years. Thirty-one per cent had an aneurysm in the thoracic aorta (67 of 217 investigated, 84% were located in the descending aorta), 13 (19%) underwent repair. Twelve per cent had a common iliac artery aneurysm (24/259, 76% were investigated). Common femoral artery aneurysms were identified in 4.3% (8/184, 54% investigated). Popliteal artery aneurysms were identified in 4.0% (6/149, 44% investigated). The prevalence of infrainguinal aneurysms was higher among patients with synchronous iliac aneurysms (40% vs. 1.6%, OR 42, 95% CI 6.4-279, p < .001). CONCLUSIONS Thoracic aortic aneurysms are common among women with AAA, most commonly affecting the descending aorta, and detection frequently results in repair. Popliteal and femoral aneurysms are not rare among women with AAA, and even common if there is a synchronous iliac aneurysm.
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Affiliation(s)
- Jonas Wallinder
- Department of Surgical Sciences, Section of Vascular Surgery, Uppsala University, Uppsala, Sweden; Department of Surgery, Sundsvall District Hospital, Sundsvall, Sweden
| | - Anna Georgiou
- Department of Surgical Sciences, Section of Vascular Surgery, Uppsala University, Uppsala, Sweden
| | - Anders Wanhainen
- Department of Surgical Sciences, Section of Vascular Surgery, Uppsala University, Uppsala, Sweden
| | - Martin Björck
- Department of Surgical Sciences, Section of Vascular Surgery, Uppsala University, Uppsala, Sweden.
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18
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Late type III endoleak after thoracic endovascular aneurysm repair and previous infrarenal stent graft implantation - a case report and review of the literature. Wideochir Inne Tech Maloinwazyjne 2017; 12:320-324. [PMID: 29062457 PMCID: PMC5649506 DOI: 10.5114/wiitm.2017.69239] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Accepted: 07/03/2017] [Indexed: 11/17/2022] Open
Abstract
Thoracic endovascular aortic repair (TEVAR) effectively improved the results of thoracic aortic aneurysm treatment. TEVAR is a less invasive procedure that can be performed under local anesthesia with shorter hospital stay. The perioperative morbidity and mortality rates are lower for endovascular than open repair, but the rate of secondary interventions is higher for TEVAR. We report a case of an elderly man with synchronous abdominal and thoracic aortic aneurysms. A type III dangerous endoleak was recognized 3 years after TEVAR. It was successfully repaired during an endovascular procedure. There were no new endoleaks after 12 months of follow-up. TEVAR may be the only option of treatment for risky and elderly patients. However, postoperative monitoring is necessary to exclude different types of endoleaks. Most of them undergo effective endovascular repair.
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19
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ACR Appropriateness Criteria ® Pulsatile Abdominal Mass Suspected Abdominal Aortic Aneurysm. J Am Coll Radiol 2017; 14:S258-S265. [DOI: 10.1016/j.jacr.2017.01.027] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2017] [Revised: 01/19/2017] [Accepted: 01/23/2017] [Indexed: 11/20/2022]
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20
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van de Luijtgaarden KM, Rouwet EV, Hoeks SE, Stolker RJ, Verhagen HJ, Majoor-Krakauer D. Risk of abdominal aortic aneurysm (AAA) among male and female relatives of AAA patients. Vasc Med 2017; 22:112-118. [PMID: 28429660 DOI: 10.1177/1358863x16686409] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Sex affects the presentation, treatment, and outcomes of abdominal aortic aneurysm (AAA). Although AAAs are less prevalent in women, at least in the general population, women with an AAA have a poorer prognosis in comparison to men. Sex differences in the genetic predisposition for aneurysm disease remain to be established. In this study we investigated the familial risk of AAA for women compared to men. All living AAA patients included in a 2004-2012 prospective database were invited to the multidisciplinary vascular/genetics outpatient clinic between 2009 and 2012 for assessment of family history using detailed questionnaires. AAA risk for male and female relatives was calculated separately and stratified by sex of the AAA patients. Families of 568 AAA patients were investigated and 22.5% of the patients had at least one affected relative. Female relatives had a 2.8-fold and male relatives had a 1.7-fold higher risk than the estimated sex-specific population risk. Relatives of female AAA patients had a higher aneurysm risk than relatives of male patients (9.0 vs 5.9%, p = 0.022), corresponding to 5.5- and 2.0-fold increases in aneurysm risk in the female and male relatives, respectively. The risk for aortic aneurysm in relatives of AAA patients is higher than expected from population risk. The excess risk is highest for the female relatives of AAA patients and for the relatives of female AAA patients. These findings endorse targeted AAA family screening for female and male relatives of all AAA patients.
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Affiliation(s)
| | - Ellen V Rouwet
- 1 Department of Vascular Surgery, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Sanne E Hoeks
- 2 Department of Anesthesiology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Robert J Stolker
- 2 Department of Anesthesiology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Hence Jm Verhagen
- 1 Department of Vascular Surgery, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Danielle Majoor-Krakauer
- 3 Department of Clinical Genetics, Erasmus University Medical Center, Rotterdam, the Netherlands
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21
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Rössel T, Paul R, Richter T, Ludwig S, Hofmockel T, Heller AR, Koch T. [Management of anesthesia in endovascular interventions]. Anaesthesist 2016; 65:891-910. [PMID: 27900415 DOI: 10.1007/s00101-016-0241-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Cardiovascular diseases are one of the leading causes of morbidity and mortality in Germany. In these patients, the high-risk profile necessitates an interdisciplinary and multimodal approach to treatment. Endovascular interventions and vascular surgery have become established as an important element of this strategy in the past; however, the different anatomical localizations of pathological vascular alterations make it necessary to use a wide spectrum of procedural options and methods; therefore, the requirements for management of anesthesia are variable and necessitate a differentiated approach. Endovascular procedures can be carried out with the patient under general or regional anesthesia (RA); however, in the currently available literature there is no evidence for an advantage of RA over general anesthesia regarding morbidity and mortality, although a reduction in pulmonary complications could be found for some endovascular interventions. Epidural and spinal RA procedures should be carefully considered with respect to the risk-benefit ratio and consideration of the recent guidelines on anesthesia against the background of the current study situation and the regular use of therapy with anticoagulants. The following article elucidates the specific characteristics of anesthesia management as exemplified by some selected endovascular interventions.
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Affiliation(s)
- T Rössel
- Klinik für Anästhesiologie und Intensivmedizin, TU Dresden, Fetscherstr. 74, 01307, Dresden, Deutschland.
| | - R Paul
- Klinik für Anästhesiologie und Intensivmedizin, TU Dresden, Fetscherstr. 74, 01307, Dresden, Deutschland
| | - T Richter
- Klinik für Anästhesiologie und Intensivmedizin, TU Dresden, Fetscherstr. 74, 01307, Dresden, Deutschland
| | - S Ludwig
- Klinik für Viszeral-, Thorax- und Gefäßchirurgie, TU Dresden, Dresden, Deutschland
| | - T Hofmockel
- Institut und Poliklinik für Radiologische Diagnostik, TU Dresden, Dresden, Deutschland
| | - A R Heller
- Klinik für Anästhesiologie und Intensivmedizin, TU Dresden, Fetscherstr. 74, 01307, Dresden, Deutschland
| | - T Koch
- Klinik für Anästhesiologie und Intensivmedizin, TU Dresden, Fetscherstr. 74, 01307, Dresden, Deutschland
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22
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van 't Hof FNG, Ruigrok YM, Lee CH, Ripke S, Anderson G, de Andrade M, Baas AF, Blankensteijn JD, Böttinger EP, Bown MJ, Broderick J, Bijlenga P, Carrell DS, Crawford DC, Crosslin DR, Ebeling C, Eriksson JG, Fornage M, Foroud T, von Und Zu Fraunberg M, Friedrich CM, Gaál EI, Gottesman O, Guo DC, Harrison SC, Hernesniemi J, Hofman A, Inoue I, Jääskeläinen JE, Jones GT, Kiemeney LALM, Kivisaari R, Ko N, Koskinen S, Kubo M, Kullo IJ, Kuivaniemi H, Kurki MI, Laakso A, Lai D, Leal SM, Lehto H, LeMaire SA, Low SK, Malinowski J, McCarty CA, Milewicz DM, Mosley TH, Nakamura Y, Nakaoka H, Niemelä M, Pacheco J, Peissig PL, Pera J, Rasmussen-Torvik L, Ritchie MD, Rivadeneira F, van Rij AM, Santos-Cortez RLP, Saratzis A, Slowik A, Takahashi A, Tromp G, Uitterlinden AG, Verma SS, Vermeulen SH, Wang GT, Han B, Rinkel GJE, de Bakker PIW. Shared Genetic Risk Factors of Intracranial, Abdominal, and Thoracic Aneurysms. J Am Heart Assoc 2016; 5:e002603. [PMID: 27418160 PMCID: PMC5015357 DOI: 10.1161/jaha.115.002603] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2015] [Accepted: 03/16/2016] [Indexed: 01/22/2023]
Abstract
BACKGROUND Intracranial aneurysms (IAs), abdominal aortic aneurysms (AAAs), and thoracic aortic aneurysms (TAAs) all have a familial predisposition. Given that aneurysm types are known to co-occur, we hypothesized that there may be shared genetic risk factors for IAs, AAAs, and TAAs. METHODS AND RESULTS We performed a mega-analysis of 1000 Genomes Project-imputed genome-wide association study (GWAS) data of 4 previously published aneurysm cohorts: 2 IA cohorts (in total 1516 cases, 4305 controls), 1 AAA cohort (818 cases, 3004 controls), and 1 TAA cohort (760 cases, 2212 controls), and observed associations of 4 known IA, AAA, and/or TAA risk loci (9p21, 18q11, 15q21, and 2q33) with consistent effect directions in all 4 cohorts. We calculated polygenic scores based on IA-, AAA-, and TAA-associated SNPs and tested these scores for association to case-control status in the other aneurysm cohorts; this revealed no shared polygenic effects. Similarly, linkage disequilibrium-score regression analyses did not show significant correlations between any pair of aneurysm subtypes. Last, we evaluated the evidence for 14 previously published aneurysm risk single-nucleotide polymorphisms through collaboration in extended aneurysm cohorts, with a total of 6548 cases and 16 843 controls (IA) and 4391 cases and 37 904 controls (AAA), and found nominally significant associations for IA risk locus 18q11 near RBBP8 to AAA (odds ratio [OR]=1.11; P=4.1×10(-5)) and for TAA risk locus 15q21 near FBN1 to AAA (OR=1.07; P=1.1×10(-3)). CONCLUSIONS Although there was no evidence for polygenic overlap between IAs, AAAs, and TAAs, we found nominally significant effects of two established risk loci for IAs and TAAs in AAAs. These two loci will require further replication.
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Affiliation(s)
- Femke N G van 't Hof
- Utrecht Stroke Center, Department of Neurology and Neurosurgery, Rudolf Magnus Institute of Neuroscience, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Ynte M Ruigrok
- Utrecht Stroke Center, Department of Neurology and Neurosurgery, Rudolf Magnus Institute of Neuroscience, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Cue Hyunkyu Lee
- Department of Convergence Medicine, University of Ulsan College of Medicine and Asan Institute for Life Sciences Asan Medical Center, Seoul, Korea Department of Neurosurgery, Helsinki University Central Hospital, Helsinki, Finland
| | - Stephan Ripke
- Analytic and Translational Genetics Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA Department of Psychiatry and Psychotherapy, Charité, Universitätsmedizin Berlin, Berlin, Germany
| | - Graig Anderson
- The George Institute for International Health, University of Sydney, Australia
| | | | - Annette F Baas
- Department of Medical Genetics, Center for Molecular Medicine, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Jan D Blankensteijn
- Department of Vascular Surgery, VU Medical Center, Amsterdam, The Netherlands
| | - Erwin P Böttinger
- Icahn School of Medicine Mount Sinai, The Charles Bronfman Institute for Personalized Medicine, New York, NY
| | - Matthew J Bown
- Department of Cardiovascular Sciences and the NIHR Leicester Cardiovascular Biomedical Research Unit, University of Leicester, United Kingdom
| | - Joseph Broderick
- Department of Neurology, University of Cincinnati School of Medicine, Cincinnati, OH
| | - Philippe Bijlenga
- Hôpitaux Universitaire de Genève et Faculté de médecine de Genève, Geneva, Switzerland
| | | | - Dana C Crawford
- Department of Epidemiology and Biostatistics, Institute for Computational Biology, Case Western Reserve University, Cleveland, OH Center for Human Genetics Research, Vanderbilt University, Nashville, TN
| | - David R Crosslin
- Division of Medical Genetics, Department of Medicine, University of Washington, Seattle, WA
| | - Christian Ebeling
- Fraunhofer Institut Algorithmen und Wissenschaftliches Rechnen, Sankt Augustin, Germany
| | - Johan G Eriksson
- Department of Chronic Disease Prevention, National Institute for Health and Welfare, Helsinki, Finland Folkhälsan Research Center, Helsinki, Finland Department of General Practice and Primary Health Care, and Helsinki University Hospital, University of Helsinki, Finland
| | - Myriam Fornage
- Human Genetics Center and Institute of Molecular Medicine, University of Texas Health Science Center, Houston, TX
| | - Tatiana Foroud
- Department of Medical and Molecular Genetics, Indiana University School of Medicine, Indianapolis, IN
| | | | - Christoph M Friedrich
- Department of Computer Science, University of Applied Science and Arts, Dortmund, Germany
| | - Emília I Gaál
- Institute for Molecular Medicine Finland (FIMM), University of Helsinki, Finland Public Health Genomics Unit, Department of Chronic Disease Prevention, National Institute for Health and Welfare, Helsinki, Finland Department of Neurosurgery, Helsinki University Central Hospital, Helsinki, Finland
| | - Omri Gottesman
- Icahn School of Medicine Mount Sinai, The Charles Bronfman Institute for Personalized Medicine, New York, NY
| | - Dong-Chuan Guo
- Department of Internal Medicine, The University of Texas Medical School at Houston, TX
| | - Seamus C Harrison
- Department of Cardiovascular Science, University of Leicester, United Kingdom
| | - Juha Hernesniemi
- Department of Neurosurgery, Helsinki University Central Hospital, Helsinki, Finland
| | - Albert Hofman
- Department of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Ituro Inoue
- Division of Human Genetics, National Institute of Genetics, Mishima, Japan
| | | | - Gregory T Jones
- Surgery Department, University of Otago, Dunedin, New Zealand
| | - Lambertus A L M Kiemeney
- Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands
| | - Riku Kivisaari
- Department of Neurosurgery, Helsinki University Central Hospital, Helsinki, Finland
| | - Nerissa Ko
- Department of Neurology, University of California, San Francisco, CA
| | - Seppo Koskinen
- Department of Health, Functional Capacity and Welfare, National Institute for Health and Welfare, Helsinki, Finland
| | - Michiaki Kubo
- Center for Integrative Medical Sciences, RIKEN, Kanagawa, Japan
| | | | - Helena Kuivaniemi
- Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands The Sigfried and Janet Weis Center for Research, Geisinger Health System, Danville, PA Department of Surgery, Temple University School of Medicine, Philadelphia, PA Department of Biomedical Sciences, Stellenbosch University, Tygerberg, South Africa
| | - Mitja I Kurki
- Neurosurgery of NeuroCenter, Kuopio University Hospital, Kuopio, Finland Center for Human Genetics Research, Massachusetts General Hospital, Boston, MA Medical and Population Genetics Program, Broad Institute, Boston, MA
| | - Aki Laakso
- Public Health Genomics Unit, Department of Chronic Disease Prevention, National Institute for Health and Welfare, Helsinki, Finland
| | - Dongbing Lai
- Department of Medical and Molecular Genetics, Indiana University School of Medicine, Indianapolis, IN
| | - Suzanne M Leal
- Center for Statistical Genetics, Baylor College of Medicine, Houston, TX
| | - Hanna Lehto
- Department of Neurosurgery, Helsinki University Central Hospital, Helsinki, Finland
| | - Scott A LeMaire
- Michael E. DeBakey Department of Surgery, Baylor College of Medicine and the Texas Heart Institute, Houston, TX
| | - Siew-Kee Low
- Center for Integrative Medical Sciences, RIKEN, Kanagawa, Japan
| | - Jennifer Malinowski
- Center for Human Genetics Research, Vanderbilt University, Nashville, TN Department of Surgery, Yale School of Medicine, New Haven, CT
| | | | - Dianna M Milewicz
- Department of Internal Medicine, The University of Texas Medical School at Houston, TX
| | - Thomas H Mosley
- Department of Medicine, University of Mississippi Medical Center, Jackson, MS
| | - Yusuke Nakamura
- Section of Hematology and Oncology, Department of Medicine, University of Chicago, IL
| | - Hirofumi Nakaoka
- Division of Human Genetics, National Institute of Genetics, Mishima, Japan
| | - Mika Niemelä
- Department of Neurosurgery, Helsinki University Central Hospital, Helsinki, Finland
| | - Jennifer Pacheco
- Center for Genetic Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Peggy L Peissig
- Center for Human Genetics, Marshfield Clinic Research Foundation, Marshfield, WI
| | - Joanna Pera
- Department of Neurology, Jagiellonian University, Krakow, Poland
| | - Laura Rasmussen-Torvik
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Marylyn D Ritchie
- Center for Systems Genomics, The Pennsylvania State University, Pennsylvania, PA
| | - Fernando Rivadeneira
- Department of Internal Medicine, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Andre M van Rij
- Surgery Department, University of Otago, Dunedin, New Zealand
| | | | - Athanasios Saratzis
- Department of Cardiovascular Sciences and the NIHR Leicester Cardiovascular Biomedical Research Unit, University of Leicester, United Kingdom
| | - Agnieszka Slowik
- Department of Neurology, Jagiellonian University, Krakow, Poland
| | | | - Gerard Tromp
- The Sigfried and Janet Weis Center for Research, Geisinger Health System, Danville, PA Department of Biomedical Sciences, Stellenbosch University, Tygerberg, South Africa
| | - André G Uitterlinden
- Department of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands Department of Internal Medicine, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Shefali S Verma
- Center for Systems Genomics, The Pennsylvania State University, Pennsylvania, PA
| | - Sita H Vermeulen
- Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands
| | - Gao T Wang
- Center for Statistical Genetics, Baylor College of Medicine, Houston, TX
| | - Buhm Han
- Department of Convergence Medicine, University of Ulsan College of Medicine and Asan Institute for Life Sciences Asan Medical Center, Seoul, Korea
| | - Gabriël J E Rinkel
- Utrecht Stroke Center, Department of Neurology and Neurosurgery, Rudolf Magnus Institute of Neuroscience, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Paul I W de Bakker
- Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
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23
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Ziganshin BA, Elefteriades JA. Guilt by association: a paradigm for detection of silent aortic disease. Ann Cardiothorac Surg 2016; 5:174-87. [PMID: 27386404 DOI: 10.21037/acs.2016.05.13] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Detection of clinically silent thoracic aortic aneurysm (TAA) is challenging due to the lack of symptoms (until aortic rupture or dissection occurs). A large proportion of TAA are identified incidentally while imaging a patient for other reasons. However, recently several clinical "associates" of TAA have been described that can aid in identification of silent TAA. These "associates" include intracranial aneurysm, aortic arch anomalies, abdominal aortic aneurysm (AAA), simple renal cysts (SRC), bicuspid aortic valve, temporal arteritis, a positive family history of aneurysm disease, and a positive thumb-palm sign. In this article we examine these associates of TAA and the data supporting their involvement with asymptomatic TAA.
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Affiliation(s)
- Bulat A Ziganshin
- 1 Aortic Institute at Yale-New Haven Hospital, Yale University School of Medicine, New Haven, CT, USA ; 2 Department of Surgical Diseases # 2, Kazan State Medical University, Kazan, Russia
| | - John A Elefteriades
- 1 Aortic Institute at Yale-New Haven Hospital, Yale University School of Medicine, New Haven, CT, USA ; 2 Department of Surgical Diseases # 2, Kazan State Medical University, Kazan, Russia
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24
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Vapnik JS, Kim JB, Isselbacher EM, Ghoshhajra BB, Cheng Y, Sundt TM, MacGillivray TE, Cambria RP, Lindsay ME. Characteristics and Outcomes of Ascending Versus Descending Thoracic Aortic Aneurysms. Am J Cardiol 2016; 117:1683-1690. [PMID: 27015890 DOI: 10.1016/j.amjcard.2016.02.048] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2015] [Revised: 02/16/2016] [Accepted: 02/16/2016] [Indexed: 11/15/2022]
Abstract
Thoracic aortic aneurysms (TAs) occur in reproducible patterns, but etiologic factors determining the anatomic distribution of these aneurysms are not well understood. This study sought to gain insight into etiologic differences and clinical outcomes associated with repetitive anatomic distributions of TAs. From 3,247 patients registered in an institutional Thoracic Aortic Center database from July 1992 to August 2013, we identified 844 patients with full aortic dimensional imaging by computerized axial tomography or magnetic resonance imaging scan (mean age 62.8 ± 14 years, 37% women, median follow-up 40 months) with TA diameter >4.0 cm and without evidence of previous aortic dissection. Patient demographic and imaging data were analyzed in 3 groups: isolated ascending thoracic aortic aneurysms (AAs; n = 628), isolated descending TAs (DTAs; n = 130), and combined AA and DTA (mixed thoracic aortic aneurysm, MTA; n = 86). Patients with DTA had more hypertension (82% vs 59%, p <0.001) and a higher burden of atherosclerosis (88% vs 9%, p <0.001) than AA. Conversely, patients with isolated AA were younger (59.5 ± 13.5 vs 71.0 ± 11.8 years, p <0.001) and contained almost every case of overt, genetically triggered TA. Patients with isolated DTA were demographically indistinguishable from patients with MTA. In follow-up, patients with DTA/MTA experienced more aortic events (aortic dissection/rupture) and had higher mortality than patients with isolated AA. In multivariate analysis, aneurysm size (odds ratio 1.1, 95% CI 1.07 to 1.16, p <0.001) and the presence of atherosclerosis (odds ratio 5.7, 95% CI 2.02 to 16.15, p <0.001) independently predicted adverse aortic events. We find that DTA with or without associated AA appears to be a disease more highly associated with atherosclerosis, hypertension, and advanced age. In contrast, isolated AA appears to be a clinically distinct entity with a greater burden of genetically triggered disease.
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Affiliation(s)
- Joshua S Vapnik
- Massachusetts General Hospital Thoracic Aortic Center, Harvard Medical School, Boston, Massachusetts; Division of Cardiology, Harvard Medical School, Boston, Massachusetts
| | - Joon Bum Kim
- Massachusetts General Hospital Thoracic Aortic Center, Harvard Medical School, Boston, Massachusetts; Division of Cardiac Surgery, Harvard Medical School, Boston, Massachusetts; Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Eric M Isselbacher
- Massachusetts General Hospital Thoracic Aortic Center, Harvard Medical School, Boston, Massachusetts; Division of Cardiology, Harvard Medical School, Boston, Massachusetts
| | | | - Yisha Cheng
- Massachusetts General Hospital Thoracic Aortic Center, Harvard Medical School, Boston, Massachusetts; Division of Cardiology, Harvard Medical School, Boston, Massachusetts
| | - Thoralf M Sundt
- Massachusetts General Hospital Thoracic Aortic Center, Harvard Medical School, Boston, Massachusetts; Division of Cardiac Surgery, Harvard Medical School, Boston, Massachusetts
| | - Thomas E MacGillivray
- Massachusetts General Hospital Thoracic Aortic Center, Harvard Medical School, Boston, Massachusetts; Division of Cardiac Surgery, Harvard Medical School, Boston, Massachusetts
| | - Richard P Cambria
- Massachusetts General Hospital Thoracic Aortic Center, Harvard Medical School, Boston, Massachusetts; Division of Vascular and Endovascular Surgery, Harvard Medical School, Boston, Massachusetts
| | - Mark E Lindsay
- Massachusetts General Hospital Thoracic Aortic Center, Harvard Medical School, Boston, Massachusetts; Division of Cardiology, Harvard Medical School, Boston, Massachusetts.
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25
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Elefteriades JA, Ziganshin BA. Paradigm for Detecting Silent Thoracic Aneurysm Disease. Semin Thorac Cardiovasc Surg 2016; 28:776-782. [PMID: 28417864 DOI: 10.1053/j.semtcvs.2016.10.006] [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] [Accepted: 10/06/2016] [Indexed: 02/07/2023]
Abstract
Thoracic aortic aneurysms (TAA) pose a serious detection challenge owing to their clinically silent nature. Only a small fraction of TAAs cause symptoms in patients. However, the mortality burden of this disease in the population is significant, given the high lethality of such complications as aortic rupture and dissection. Widespread screening for TAA has not been shown to be cost-effective. Therefore, currently most patients with a TAA are identified incidentally during an imaging study conducted for other reasons. Once a TAA diagnosis is established, prophylactic surgical treatment can safely be performed for aneurysms of the ascending aorta, aortic arch, and descending or thoracoabdominal aorta, thus preventing aneurysm-related death. To facilitate early detection of TAA, recent studies have identified several "associates" of TAA that may be useful in making a timely diagnosis. These "associates" include intracranial aneurysm, aortic arch anomalies, abdominal aortic aneurysm, simple renal cysts, bicuspid aortic valve, temporal arteritis, a positive family history of aneurysm disease, and a positive thumb-palm sign, among others. Although for many of these "associates" the underlying mechanism that would explain the association remains to be elucidated, the clinical correlation is strong enough to suggest screening patients with these findings for TAA. This article introduces the "Guilt by Association" paradigm for detection of silent thoracic aortic disease based on detection of clinical markers associated with this condition.
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Affiliation(s)
- John A Elefteriades
- Aortic Institute at Yale-New Haven Hospital, Yale University School of Medicine, New Haven, Connecticut.
| | - Bulat A Ziganshin
- Aortic Institute at Yale-New Haven Hospital, Yale University School of Medicine, New Haven, Connecticut; Department of Surgical Diseases #2, Kazan State Medical University, Kazan, Russia
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26
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Evaluation for abdominal aortic aneurysms is justified in patients with thoracic aortic aneurysms. Int J Cardiovasc Imaging 2015; 32:647-53. [PMID: 26602411 DOI: 10.1007/s10554-015-0807-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2015] [Accepted: 11/15/2015] [Indexed: 10/22/2022]
Abstract
Aortic aneurysms are a significant cause of mortality, and the presence of multiple aneurysms may affect treatment plans. The purpose of this study was to determine the frequency of abdominal aortic aneurysms (AAAs) in patients with thoracic aortic aneurysms (TAAs) and to establish whether patient specific factors, such as gender and comorbidities, influenced the frequency of AAAs, thereby indicating if and when abdominal aortic evaluation is justified. Electronic medical records were reviewed from 1000 patients with a computed tomography (CT) angiogram of the chest and abdomen and a clinical diagnosis of TAA from Cardiac Surgery clinic between 2008 and 2013. 538 patients with history of aortic intervention, dissection, rupture or trauma were excluded. The frequency of AAAs among the 462 remaining patients was established, and statistical analysis was used to elucidate differences in frequency based on age, gender, comorbidities, and TAA location. Overall, 104 of 462 (22.5 %) patients with a TAA also had an AAA. There were significant differences in the frequency of AAA based on TAA location, age, and comorbidities. The following comorbidities showed positive associations with AAA using logistic regression analysis: age ≥65 (P < 0.0001; OR 30.1; CI 7.14-126.61), smoking history (P < 0.0001; OR 4.1; 2.35-7.30), and hypertension (P = 0.024; OR 2.1; CI 1.11-4.16). Aneurysms in the proximal/mid descending (P < 0.0001; OR 4.96; CI 2.32-10.61) and diaphragm level (P < 0.0001; OR 38.4; CI 14.71-100.15) of the aorta also showed a positive association with AAAs when adjusted for age and gender. AAA screening in patients with TAA is a reasonable, evidence-based option regardless of the TAA location, with the strongest support in patients >age 55, with systemic hypertension, a smoking history and/or a TAA in the descending thoracic aorta.
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27
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Gutierrez PS, Leite TNP, Mangione FM. Male gender and smoking are related to single, but not to multiple, human aortic aneurysms. Cardiovasc Pathol 2015; 24:290-3. [PMID: 26071928 DOI: 10.1016/j.carpath.2015.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2015] [Revised: 05/29/2015] [Accepted: 05/30/2015] [Indexed: 11/26/2022] Open
Abstract
UNLABELLED There is scanty information concerning multiple aortic aneurysms. Thus, we verified if clinical or pathological characteristics are different in patients with multiple (two or more) aortic aneurysms in comparison with those with only one. MATERIAL AND METHODS We selected at the necropsy files of the Heart Institute, São Paulo University School of Medicine, the last 100 cases with aortic aneurysms, comparing between the two groups: sex, age, presence of systemic arterial hypertension, diabetes, dyslipedemia, history of smoking habit, cause of the aneurysm, cause of death, and if the diagnosis was reached during life. Age was analysed by Mann-Whitney test, and the other variables by chi-square or Fisher's exact test. RESULTS Multiple aneurysms corresponded to 14% of cases. The proportion of women among patients with multiple aneurysms was higher than among those with single aneurysm (64.3% versus 20.9%, P<.01), even if only cases with atherosclerosis were taken into consideration (women among multiple-6/10, 60.0%; among single-14/70, 20.0%; P=.01). Smoking was less reported in cases with multiple (4/14, 28.6%) than with single aneurysm (53/86, 61.6%; P=.04); considering cases with atherosclerosis, such difference decreases (40.0% of multiple versus 68.6% of single, P=.09). CONCLUSION although atherosclerosis is present in most cases of both single and multiple aortic aneurysms, male gender and smoking, considered highly influential in such lesions, are less frequent in patients with multiple than in patients with single aneurysms. Thus mechanisms underlying multiple aortic aneurysms are probably different from those related to single, more common aneurysms.
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Affiliation(s)
- Paulo S Gutierrez
- Laboratory of Pathology, Heart Institute (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.
| | - Thiago N P Leite
- Clinical Division, Heart Institute (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Fernanda M Mangione
- Clinical Division, Heart Institute (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
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28
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van de Luijtgaarden KM, Verhagen HJM. What a vascular surgeon should know about familial abdominal aortic aneurysm. Eur J Vasc Endovasc Surg 2015; 50:137-8. [PMID: 25902934 DOI: 10.1016/j.ejvs.2015.03.036] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2015] [Accepted: 03/18/2015] [Indexed: 01/21/2023]
Affiliation(s)
- K M van de Luijtgaarden
- Department of Vascular Surgery, Erasmus University Medical Center, Rotterdam 3000 CA, The Netherlands
| | - H J M Verhagen
- Department of Vascular Surgery, Erasmus University Medical Center, Rotterdam 3000 CA, The Netherlands.
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29
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Abstract
BACKGROUND The study hypothesis was that thoracic aortic disease (TAD) is associated with a higher-than-expected prevalence of inguinal hernia. Such an association has been reported for abdominal aortic aneurysm (AAA) and hernia. Unlike AAA, TAD is not necessarily detectable with clinical examination or ultrasound, and there are no population-based screening programs for TAD. Therefore, conditions associated with TAD, such as inguinal hernia, are of particular clinical relevance. METHODS AND RESULTS The prevalence of inguinal hernia in subjects with TAD was determined from nation-wide register data and compared to a non-TAD group (patients with isolated aortic stenosis). Groups were balanced using propensity score matching. Multivariable statistical analysis (logistic regression) was performed to identify variables independently associated with hernia. Hernia prevalence was 110 of 750 (15%) in subjects with TAD versus 29 of 301 (9.6%) in non-TAD, P=0.03. This statistically significant difference remained after propensity score matching: 21 of 159 (13%) in TAD versus 14 of 159 (8.9%) in non-TAD, P<0.001. Variables independently associated with hernia in multivariable analysis were male sex (odds ratio [OR] with 95% confidence interval [95% CI]) 3.4 (2.1 to 5.4), P<0.001; increased age, OR 1.02/year (1.004 to 1.04), P=0.014; and TAD, OR 1.8 (1.1 to 2.8), P=0.015. CONCLUSIONS The prevalence of inguinal hernia (15%) in TAD is higher than expected in a general population and higher in TAD, compared to non-TAD. TAD is independently associated with hernia in multivariable analysis. Presence or history of hernia may be of importance in detecting TAD, and the association warrants further study.
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Affiliation(s)
- Christian Olsson
- Cardiovascular Surgery Unit, Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden (C.O., A.F.C.)
| | - Per Eriksson
- Atherosclerosis Research Unit, Department of Medicine, Karolinska Institute, Stockholm, Sweden (P.E.)
| | - Anders Franco-Cereceda
- Cardiovascular Surgery Unit, Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden (C.O., A.F.C.)
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30
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Abstract
The incidence and operations of thoracic and thoracoabdominal aortic aneurysms have significantly increased. The indications for repair are considered to be a diameter of 6 cm or more and 5.5 cm for patient groups with increased risk of rupture. Complex open surgical repair is associated with significant mortality and complication rates. Total or hybrid endovascular repair seems to reduce early postoperative complications and mortality. The endovascular approach has evolved to be a good and predominant alternative to open repair of these aneurysms for older and high-risk patients as well as for aneurysms with optimal morphological suitability. Notwithstanding, at present a complete paradigm shift from open to endovascular repair for all patients, especially those with complex aneurysms, cannot yet be established.
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Affiliation(s)
- J Zanow
- Klinik für Allgemein-, Viszeral- und Gefäßchirurgie, Universitätsklinikum Jena, Erlanger Allee 101, 07740, Jena, Deutschland,
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31
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Martufi G, Gasser TC, Appoo JJ, Di Martino ES. Mechano-biology in the thoracic aortic aneurysm: a review and case study. Biomech Model Mechanobiol 2014; 13:917-28. [DOI: 10.1007/s10237-014-0557-9] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2013] [Accepted: 01/27/2014] [Indexed: 01/22/2023]
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32
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Prevalence of thoracic ascending aortic aneurysm in adult patients with known abdominal aortic aneurysm: An echocardiographic study. Int J Cardiol 2013; 168:3147-8. [DOI: 10.1016/j.ijcard.2013.04.162] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2013] [Accepted: 04/13/2013] [Indexed: 11/24/2022]
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33
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Jackson V, Olsson C, Eriksson P, Franco-Cereceda A. Aortic dimensions in patients with bicuspid and tricuspid aortic valves. J Thorac Cardiovasc Surg 2013; 146:605-10. [DOI: 10.1016/j.jtcvs.2012.07.039] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2012] [Revised: 05/29/2012] [Accepted: 07/25/2012] [Indexed: 11/25/2022]
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34
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François CJ. Noninvasive Imaging Workup of Patients with Vascular Disease. Surg Clin North Am 2013; 93:741-60, vii. [DOI: 10.1016/j.suc.2013.04.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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35
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Hultgren R, Vishnevskaya L, Wahlgren CM. Women with abdominal aortic aneurysms have more extensive aortic neck pathology. Ann Vasc Surg 2013; 27:547-52. [PMID: 23522442 DOI: 10.1016/j.avsg.2012.05.025] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2011] [Revised: 02/10/2012] [Accepted: 05/06/2012] [Indexed: 01/13/2023]
Abstract
BACKGROUND The proportion of women with abdominal aortic aneurysm (AAA) treated with endovascular aortic repair (EVAR) is lower than for open repair (OR). Unfavorable morphologic features for EVAR in women with AAA may explain this disproportion. The objective of this study was to identify morphologic features in AAA patients undergoing elective repair with special emphasis on gender differences. METHODS Patients undergoing elective repair from January 1, 2006 to December 31, 2008 at our university's vascular unit were included in this study. Computed tomography (CT) angiograms were analyzed. Morphologic features considered unfavorable for EVAR rather than open repair (OR) included: infrarenal aortic neck <15 mm; angulation >60°; circumferential neck thrombus; neck width >32 mm; iliac arteries <7.5 mm; or presence of bi-iliac aneurysms. Complex aortic neck was defined as a neck length of <15 mm and one or more of the other aortic neck exclusion criteria. RESULTS One hundred seventy-two patients, including 140 men and 32 women, were treated during the study period, which included 99 with OR (21 women, 78 men) and 73 with EVAR (11 women, 62 men). Morphologic unsuitability for EVAR was 44% (75 of 172) and was not statistically different between women and men [47% (15 of 32) vs. 43% (60 of 140), P = 0.70]. Aortic neck pathology was the dominating feature for unsuitability for EVAR (69 of 75, 92%), and 85 of 172 patients had an unsuitable aortic neck. This rate was not different between women and men [19 of 32 (59%) vs. 66 of 140 (47%), P = 0.24]. Iliac unsuitability rates were 11% (19 of 172) and were not different between women and men [4 of 32 (12%) vs. 15 of 140 (11%), P = 0.76]. In patients unsuitable for EVAR, the proximal aortic necks showed more extensive aortic neck pathology in women than in men [8 of 15 (53%) vs. 13 of 60 (22%), P = 0.02]. More men had only short neck pathology [22 of 60 (37%) vs. 1 of 15 (7%), P = 0.03]. CONCLUSIONS Aortic neck pathology is the dominating cause of EVAR exclusion in both genders. A higher proportion of women have more pathologic neck anatomy. Future development of EVAR devices should focus on the complexity of the aortic neck, which will benefit all AAA patients, but especially women.
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Affiliation(s)
- Rebecka Hultgren
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.
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36
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Female and Elderly Abdominal Aortic Aneurysm Patients More Commonly Have Concurrent Thoracic Aortic Aneurysm. Ann Vasc Surg 2012; 26:918-23. [DOI: 10.1016/j.avsg.2012.01.023] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2011] [Revised: 01/15/2012] [Accepted: 01/28/2012] [Indexed: 11/19/2022]
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37
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Proximal thoracic aortic diameter measurements at CT: repeatability and reproducibility according to measurement method. Int J Cardiovasc Imaging 2012; 29:479-88. [PMID: 22864960 DOI: 10.1007/s10554-012-0102-9] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2012] [Accepted: 07/14/2012] [Indexed: 02/06/2023]
Abstract
AIM To determine the variability in CT measurements of proximal thoracic aortic diameters obtained using double-oblique short axis and semiautomatic centerline analysis techniques. Institutional review board approval, with waiver of informed consent, was obtained for this HIPAA-compliant, retrospective study. Cardiac gated thoracic aortic CT scans were evaluated in 25 patients. Maximum aortic diameter measurements at the annulus, sinuses, sinotubular junction and ascending aorta were generated using double-oblique short axis and semiautomatic centerline analysis techniques. Intraobserver and interobserver variability and variability between techniques were assessed using the Wilcoxon signed rank test, Spearman's correlation coefficients and Bland-Altman plots. Mean intraobserver diameter differences using double oblique views ranged from -0.3 to 0.6 mm. The 95 % confidence interval for difference in diameters was ±2.4 to ±5.1 mm for radiologist #1 and ±2.6 to ±5.2 mm for radiologist #2, depending on location. Mean intraobserver diameter differences using centerline analysis ranged from 0.2 to 2.3 mm, and the 95 % confidence interval for difference in diameters was ±2.0 to ±4.6 mm, depending on location. Significant interobserver differences were seen for both double oblique views and centerline analysis. Measurements obtained using the two methods were strongly correlated (r = 0.81-0.99), although they were consistently larger using centerline analysis (95 % confidence interval, ±1.8 to ±3.2 mm). Although measurement variability of the proximal thoracic aorta was generally low using double oblique and centerline analysis techniques, differences of up to approximately 5 mm in diameter occurred within the 95 % confidence interval. Neither technique was clearly more reliable than the other.
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38
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Artemiou P, Charokopos N, Rouska E, Sabol F, Chrysogonidis I, Tsavdaridou V, Paschalidis G. C-reactive protein/interleukin-6 ratio as marker of the size of the uncomplicated thoracic aortic aneurysms. Interact Cardiovasc Thorac Surg 2012; 15:871-7. [PMID: 22843654 DOI: 10.1093/icvts/ivs331] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES The role of C-reactive protein (CRP) and interleukin-6 (IL-6) as markers in the prognosis of asymptomatic thoracic aortic aneurysm (TAA) patients has not been well established. As such, we evaluated a group of patients for a possible association between serum CRP and IL-6 and aneurysm dimension. METHODS Serum CRP and IL-6 were determined and aneurysmal size was measured in 26 patients with TAA. RESULTS The mean (SD) CRP and IL-6 were 0.58 (1.07) and 7.47 (17.78) pg/ml, respectively. Serum CRP, IL-6 and the ratio CRP/IL-6 correlated with the descending aortic aneurysmal dimension (r = 0.426, r = 0.743 and r = 0.328, respectively). A significant correlation was also found between values of the ratio above 0.8 and aneurysmal dimension (both ascending and descending aneurysms) (r = 0.785). Additionally, a significant association between smoking, age group above 69 years and dyslipidemia and aneurysm dimension was established (P = 0.002, P = 0.061 and P = 0.070, respectively). CONCLUSIONS This report shows that serum CRP, IL-6 levels and the ratio CRP/IL-6 are associated with descending aortic aneurysmal dimensions. Also values of the ratio CRP/IL-6 above 0.8 are associated with aneurysmal dimensions for both ascending and descending aortic aneurysms. It is still early to establish the clinical significance of those findings, and further studies with larger groups of patients with longer follow-up are required in order to truly assess the usefulness of the serum CRP and IL-6 as markers in relation to the progression of the disease.
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Affiliation(s)
- Panagiotis Artemiou
- Department of Cardiac Surgery, AHEPA University Hospital, Thessaloniki, Greece
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ACR Appropriateness Criteria® pulsatile abdominal mass, suspected abdominal aortic aneurysm. Int J Cardiovasc Imaging 2012; 29:177-83. [PMID: 22644671 PMCID: PMC3550697 DOI: 10.1007/s10554-012-0044-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2012] [Accepted: 03/23/2012] [Indexed: 12/17/2022]
Abstract
Clinical palpation of a pulsating abdominal mass alerts the clinician to the presence of a possible abdominal aortic aneurysm (AAA). Generally an arterial aneurysm is defined as a localized arterial dilatation ≥50% greater than the normal diameter. Imaging studies are important in diagnosing the cause of a pulsatile abdominal mass and, if an AAA is found, in determining its size and involvement of abdominal branches. Ultrasound (US) is the initial imaging modality of choice when a pulsatile abdominal mass is present. Noncontrast computed tomography (CT) may be substituted in patients for whom US is not suitable. When aneurysms have reached the size threshold for intervention or are clinically symptomatic, contrast-enhanced multidetector CT angiography (CTA) is the best diagnostic and preintervention planning study, accurately delineating the location, size, and extent of aneurysm and the involvement of branch vessels. Magnetic resonance angiography (MRA) may be substituted if CT cannot be performed. Catheter arteriography has some utility in patients with significant contraindications to both CTA and MRA. The American College of Radiology Appropriateness Criteria(®) are evidence-based guidelines for specific clinical conditions that are reviewed every 2 years by a multidisciplinary expert panel. The guideline development and review include an extensive analysis of current medical literature from peer reviewed journals and the application of a well-established consensus methodology (modified Delphi) to rate the appropriateness of imaging and treatment procedures by the panel. In those instances where evidence is lacking or not definitive, expert opinion may be used to recommend imaging or treatment.
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Morphological State as a Predictor for Reintervention and Mortality After EVAR for AAA. Cardiovasc Intervent Radiol 2011; 35:1009-15. [DOI: 10.1007/s00270-011-0229-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2011] [Accepted: 06/23/2011] [Indexed: 10/18/2022]
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Michel JB, Martin-Ventura JL, Egido J, Sakalihasan N, Treska V, Lindholt J, Allaire E, Thorsteinsdottir U, Cockerill G, Swedenborg J. Novel aspects of the pathogenesis of aneurysms of the abdominal aorta in humans. Cardiovasc Res 2011; 90:18-27. [PMID: 21037321 PMCID: PMC3058728 DOI: 10.1093/cvr/cvq337] [Citation(s) in RCA: 239] [Impact Index Per Article: 18.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2010] [Revised: 10/04/2010] [Accepted: 10/20/2010] [Indexed: 01/22/2023] Open
Abstract
Aneurysm of the abdominal aorta (AAA) is a particular, specifically localized form of atherothrombosis, providing a unique human model of this disease. The pathogenesis of AAA is characterized by a breakdown of the extracellular matrix due to an excessive proteolytic activity, leading to potential arterial wall rupture. The roles of matrix metalloproteinases and plasmin generation in progression of AAA have been demonstrated both in animal models and in clinical studies. In the present review, we highlight recent studies addressing the role of the haemoglobin-rich, intraluminal thrombus and the adventitial response in the development of human AAA. The intraluminal thrombus exerts its pathogenic effect through platelet activation, fibrin formation, binding of plasminogen and its activators, and trapping of erythrocytes and neutrophils, leading to oxidative and proteolytic injury of the arterial wall. These events occur mainly at the intraluminal thrombus-circulating blood interface, and pathological mediators are conveyed outwards, where they promote matrix degradation of the arterial wall. In response, neo-angiogenesis, phagocytosis by mononuclear cells, and a shift from innate to adaptive immunity in the adventitia are observed. Abdominal aortic aneurysm thus represents an accessible spatiotemporal model of human atherothrombotic progression towards clinical events, the study of which should allow further understanding of its pathogenesis and the translation of pathogenic biological activities into diagnostic and therapeutic applications.
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Affiliation(s)
- Jean-Baptiste Michel
- Inserm Unit 698, Cardiovascular Remodelling, Denis Diderot University, Hôpital X. Bichat, Paris, France.
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