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Lin ZP, He HQ, Aierken Y, Wu Y, Liu Y. Effect of serum uric acid on the risk of aortic aneurysm and dissection: A mendelian randomization analysis. Biochem Biophys Rep 2024; 38:101743. [PMID: 38873223 PMCID: PMC11170348 DOI: 10.1016/j.bbrep.2024.101743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Revised: 05/14/2024] [Accepted: 05/26/2024] [Indexed: 06/15/2024] Open
Abstract
Aortic aneurysm and dissection (AAD) are severe vascular diseases with high mortality rates. However, the causal relationship between serum uric acid levels and the occurrence of AAD remains a subject of controversy. To address this issue, we conducted a two-sample Mendelian randomization (MR) analysis to investigate whether there is a causal association between these factors. We obtained single-nucleotide polymorphisms (SNPs) data related to serum uric acid levels from the FinnGen study and data on AAD from the UK Biobank. Various two-sample MR methods, including inverse variance weighted (IVW) analysis, MR-Egger regression analysis, weighted median analysis, and contamination mixture method, were employed to assess the causal relationship between serum uric acid and the risk of AAD. Sensitivity analysis was conducted to evaluate the stability and reliability of the results. The findings revealed a positive association between serum uric acid levels and the risk of aortic aneurysm (AA) (odds ratio [OR] = 1.200, 95 % confidence interval [CI]: 1.020-1.400, P = 0.0239). However, no significant correlation was observed between serum uric acid levels and the occurrence of aortic dissection (AD) (OR = 0.893, 95 % CI = 0.602-1.326, P = 0.576). Our study, which employed MR analysis, identified a positive association between serum uric acid levels and the risk of AA. However, we did not observe a significant correlation with AD.
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Affiliation(s)
- Zi-Peng Lin
- Department of Vascular Surgery, The Affiliated Hospital, Southwest Medical University, Luzhou, 646000, China
| | - Hu-Qiang He
- Department of Vascular Surgery, The Affiliated Hospital, Southwest Medical University, Luzhou, 646000, China
- Key Laboratory of Medical Electrophysiology, Ministry of Education & Medical Electrophysiological Key Laboratory of Sichuan Province, (Collaborative Innovation Center for Prevention of Cardiovascular Diseases) Institute of Cardiovascular Research, Southwest Medical University, Luzhou, 646000, China
- Department of General Surgery, The Affiliated Hospital, Southwest Medical University, Luzhou, 646000, China
| | - Yierpani Aierken
- Department of Vascular Surgery, The Affiliated Hospital, Southwest Medical University, Luzhou, 646000, China
| | - Ya Wu
- Department of Vascular Surgery, The Affiliated Hospital, Southwest Medical University, Luzhou, 646000, China
- Metabolic Vascular Disease Key Laboratory of Sichuan Province, The Affiliated Hospital, Southwest Medical University, 646000, Luzhou, China
| | - Yong Liu
- Department of Vascular Surgery, The Affiliated Hospital, Southwest Medical University, Luzhou, 646000, China
- Key Laboratory of Medical Electrophysiology, Ministry of Education & Medical Electrophysiological Key Laboratory of Sichuan Province, (Collaborative Innovation Center for Prevention of Cardiovascular Diseases) Institute of Cardiovascular Research, Southwest Medical University, Luzhou, 646000, China
- Department of General Surgery, The Affiliated Hospital, Southwest Medical University, Luzhou, 646000, China
- Metabolic Vascular Disease Key Laboratory of Sichuan Province, The Affiliated Hospital, Southwest Medical University, 646000, Luzhou, China
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Carnevale ML, Koleilat I, Lipsitz EC, Friedmann P, Indes JE. Reply. J Vasc Surg 2021; 73:1113-1114. [PMID: 33632501 DOI: 10.1016/j.jvs.2020.10.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Accepted: 10/23/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Matthew L Carnevale
- Division of Vascular and Endovascular Surgery, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY
| | - Issam Koleilat
- Division of Vascular and Endovascular Surgery, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY
| | - Evan C Lipsitz
- Division of Vascular and Endovascular Surgery, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY
| | - Patricia Friedmann
- Department of Cardiovascular and Thoracic Surgery, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY
| | - Jeffrey E Indes
- Division of Vascular and Endovascular Surgery, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY
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Ilonzo N, Goldberger C, Hwang S, Rao A, Faries P, Marin M, Tadros R. The Effect of Patient and Hospital Characteristics on Total Costs of Peripheral Bypass in New York State. Vasc Endovascular Surg 2021; 55:434-440. [PMID: 33590811 DOI: 10.1177/1538574421993317] [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: 11/16/2022]
Abstract
INTRODUCTION With the aging U.S. population, peripheral vascular procedures will become increasingly common. The objective of this study is to characterize the factors associated with increased total costs after peripheral bypass surgery. METHODS Data for 34,819 patients undergoing peripheral bypass surgery in NY State were extracted using the Statewide Planning and Research Cooperative System (SPARCS) database for years 2009-2017. Patient demographics, All Patient Refined Diagnostic Related Groups (APR) severity score, mortality risk, hospital volume, and length of stay data were collected. Primary outcomes were total costs and length of stay. Data were analyzed using univariate and multivariate analysis. RESULTS 28.1% of peripheral bypass surgeries were performed in New York City. 7.9% of patients had extreme APR severity of illness whereas 32.0% had major APR severity of illness. 6.3% of patients had extreme risk of mortality and 1 in every 5 patients (20%) had major risk of mortality. 24.9% of patients were discharged to a facility. The mean length of stay (LOS) was 9.9 days. Patient LOS of 6-11 days was associated with +$2,791.76 total costs. Mean LOS of ≥ 12 days was associated with + $27,194.88 total costs. Multivariate analysis revealed risk factors associated with an admission listed in the fourth quartile of total costs (≥$36,694.44) for peripheral bypass surgery included NYC location (2.82, CI 2.62-3.04), emergency surgery (1.12, CI 1.03-1.22), extreme APR 2.08, 1.78-2.43, extreme risk of mortality (2.73, 2.34-3.19), emergency room visit (1.68, 1.57-1.81), discharge to a facility (1.27, CI 1.15-1.41), and LOS in the third or fourth quartile (11.09, 9.87-12.46). CONCLUSION The cost of peripheral bypass surgery in New York State is influenced by a variety of factors including LOS, patient comorbidity and disease severity, an ER admission, and discharge to a facility.
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Affiliation(s)
- Nicole Ilonzo
- Division of Vascular Surgery, Department of Surgery, 5925The Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Cody Goldberger
- Division of Vascular Surgery, Department of Surgery, 5925The Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Songhon Hwang
- Division of Vascular Surgery, Department of Surgery, 5925The Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Ajit Rao
- Division of Vascular Surgery, Department of Surgery, 5925The Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Peter Faries
- Division of Vascular Surgery, Department of Surgery, 5925The Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Michael Marin
- Division of Vascular Surgery, Department of Surgery, 5925The Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Rami Tadros
- Division of Vascular Surgery, Department of Surgery, 5925The Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Epidemiology and management of aortic disease: aortic aneurysms and acute aortic syndromes. Nat Rev Cardiol 2020; 18:331-348. [PMID: 33353985 DOI: 10.1038/s41569-020-00472-6] [Citation(s) in RCA: 155] [Impact Index Per Article: 38.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/26/2020] [Indexed: 12/16/2022]
Abstract
The aorta is the 'greatest artery', through which oxygenated blood is delivered from the left ventricle to end organs with each cardiac cycle (200 million litres of blood transported in an average lifetime). The aorta can be affected by a wide spectrum of acute factors (such as cocaine use, weight lifting and trauma) and chronic acquired and/or genetic conditions (such as systemic arterial hypertension and phaeochromocytoma), which variously lead to increased aortic wall stress. The medial layer of the aorta can also be subject to abnormalities (such as Marfan syndrome, bicuspid aortic valve, inflammatory vasculitis, atherosclerosis and infections). Despite important advances in diagnostic and therapeutic interventions, data derived from registries and population-based studies highlight that the burden of aortic diseases remains high. Therefore, specific resources need to be allocated to design and implement preventive strategies (healthy lifestyles, modifications to cardiovascular risk factors, and educational and screening programmes) at individual and community levels. In this Review, we discuss the epidemiology, management and outcomes of the most common aortic diseases, namely, aortic aneurysms and acute aortic syndromes.
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Bradley NA, Roxburgh C, Khan F, Guthrie G. Postimplantation syndrome in endovascular aortic aneurysm repair - a systematic review. VASA 2020; 50:174-185. [PMID: 33138736 DOI: 10.1024/0301-1526/a000913] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Postimplantation syndrome (PIS) following endovascular aortic aneurysm repair (EVAR) is a poorly understood phenomenon occurring in the early post-operative course. The underlying aetiology, risk factors, clinical sequalae, and treatment options, are largely unknown. The lack of any standardised diagnostic criteria limits current research in this field. The MEDLINE database was interrogated using a Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) search strategy. Five search terms were used; "postimplantation syndrome" AND "aneurysm", AND "infection", AND "complications", AND "biomarkers", AND "outcomes". 19 studies were included in the review process, reporting a 17.4%-39.0% incidence of PIS. IL-6 was the most commonly elevated biomarker in PIS vs. non-PIS patients. There was a higher incidence of PIS in patients who received polyester rather than expanded-polytetrafluoroethylene (ePTFE) grafts. There was a lower rate of type 2 endoleaks observed in patients who developed PIS. Early major adverse cardiovascular events (MACE) were higher in PIS patients, however there were no studies reporting long-term MACE. Length of stay was higher in PIS patients. Current data support the role of IL-6 as being key to the development of PIS following EVAR. Further work describing the effect that PIS has on long-term clinical outcomes is needed. Lack of standardised diagnostic criteria limit the reporting of PIS between centres, the criteria proposed by this review may resolve this.
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Affiliation(s)
| | | | - Faisel Khan
- School of Medicine, University of Dundee, UK
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FitÉ J, Gimenez E, Soto B, Artigas V, Escudero JR, Bellmunt-Montoya S, Espallargues M. Systematic review on abdominal aortic aneurysm screening cost-efficiency and methodological quality assessment. INT ANGIOL 2020; 40:67-76. [PMID: 33086780 DOI: 10.23736/s0392-9590.20.04547-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
INTRODUCTION Abdominal aortic aneurysm (AAA) is a silent, progressive disease that can lead to death. It is easily diagnosed with noninvasive methods and its routine treatment has excellent results. This creates an optimal situation for population screening programs. The aim of this paper was to assess results and methodological quality of cost-utility studies on screening versus no screening scenarios for AAA to assess future establishment of new AAA screening programs. EVIDENCE ACQUISITON A systematic review of efficiency (cost-effectiveness and cost-utility) studies was performed, finally selecting cost-utility studies on AAA screening versus no screening. Papers were selected that dealt with efficiency of screening for AAA according to PICOTS framework and the methodological quality assessed according to the economic evaluation analyses described by Drummond and Caro. Two independent reviewers were involved in the procedure. EVIDENCE SYNTHESIS Research retrieved 88 studies. From those, 26 showed cost-effectiveness and cost-utility results. Finally, 10 studies had cost-utility results and suited criteria (published in the last 10 years; time-horizon: 10 years or more) for exhaustive analysis. All publications, except one, showed adequate incremental cost-utility ratios according to different national perspectives. Methodological assessment showed some quality limitations, but the majority of items analyzed were favorably answered after applying the questionnaires. CONCLUSIONS Confirmation of the cost-utility results in this revision at a national/regional level should be the basis for the implantation of new national screening programs worldwide. The methodological evaluation applied in this revision is crucial for the corresponding future piggy-back trials to assess routine application of national AAA screening programs.
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Affiliation(s)
- Joan FitÉ
- Centro de Investigación Biomédica en Red (CIBER) Cardiovascular, Department of Vascular Surgery, Hospital de la Santa Creu i Sant Pau, Universitat Autónoma de Barcelona, Barcelona, Spain.,Universitat Autónoma de Barcelona, Barcelona, Spain
| | - Emmanuel Gimenez
- Agència de Qualitat i Avaluació Sanitàries de Catalunya (AQuAS), Generalitat de Catalunya, Barcelona, Spain
| | - Begoña Soto
- Centro de Investigación Biomédica en Red (CIBER) Cardiovascular, Department of Vascular Surgery, Hospital de la Santa Creu i Sant Pau, Universitat Autónoma de Barcelona, Barcelona, Spain.,Universitat Autónoma de Barcelona, Barcelona, Spain
| | - Vicente Artigas
- Centro de Investigación Biomédica en Red (CIBER) Cardiovascular, Department of Vascular Surgery, Hospital de la Santa Creu i Sant Pau, Universitat Autónoma de Barcelona, Barcelona, Spain.,Universitat Autónoma de Barcelona, Barcelona, Spain
| | - Jose R Escudero
- Centro de Investigación Biomédica en Red (CIBER) Cardiovascular, Department of Vascular Surgery, Hospital de la Santa Creu i Sant Pau, Universitat Autónoma de Barcelona, Barcelona, Spain.,Universitat Autónoma de Barcelona, Barcelona, Spain
| | - Sergi Bellmunt-Montoya
- Universitat Autónoma de Barcelona, Barcelona, Spain - .,Department of Vascular Surgery, Hospital Universitari Vall d'Hebron, University of Barcelona, Barcelona, Spain
| | - Mireia Espallargues
- Agència de Qualitat i Avaluació Sanitàries de Catalunya (AQuAS), Generalitat de Catalunya, Barcelona, Spain.,Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Barcelona, Spain
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7
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Ecografía clínica en el riesgo cardiovascular. Rev Clin Esp 2020; 220:364-373. [DOI: 10.1016/j.rce.2019.11.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2019] [Accepted: 11/09/2019] [Indexed: 11/16/2022]
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8
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Beltrán L, Rodilla E. Clinical ultrasonography in cardiovascular risk. Rev Clin Esp 2020. [DOI: 10.1016/j.rceng.2020.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Multicentre Covariate Adjustment Analysis of Short-Term and 5-Year Outcomes after Endovascular Repair according to Sex. Surg Res Pract 2020; 2020:8970759. [PMID: 32232118 PMCID: PMC7085369 DOI: 10.1155/2020/8970759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Accepted: 02/04/2020] [Indexed: 11/17/2022] Open
Abstract
Background Several studies have reported worse outcomes in women compared to men after endovascular aneurysm repair (EVAR). This study aimed to evaluate sex-specific short-term and 5-year outcomes after EVAR. Methods A total of 409 consecutive patients underwent elective EVAR from 2004 to 2017 at two tertiary hospitals in Western Australia. Baseline, intraoperative, and postoperative variables were examined retrospectively according to sex. The primary outcome was 30-day mortality (death within 30 days after EVAR). Secondary outcomes were 30-day composite endpoint, length of stay after EVAR, 5-year survival, freedom from reintervention, residual aneurysm size after EVAR, and major adverse event rate at 5-year follow-up. Results A cohort of 409 patients, comprising 57 women (14%) and 352 men (86%), was analysed. Female patients were older (median age, 76.8 versus 73.5 years, p=0.017). Male patients were more likely to be past smokers (40.9% versus 22.8%, p=0.017). Male patients were more likely to be past smokers (40.9% versus 22.8%, p=0.017). Male patients were more likely to be past smokers (40.9% versus 22.8%, p=0.017). Male patients were more likely to be past smokers (40.9% versus 22.8%, p=0.017). Male patients were more likely to be past smokers (40.9% versus 22.8%, p=0.017). Male patients were more likely to be past smokers (40.9% versus 22.8%, p=0.017). Male patients were more likely to be past smokers (40.9% versus 22.8%. Conclusion This study found no significant differences in 30-day and 5-year outcomes between female and male patients treated with EVAR, implying that EVAR remains a safe treatment choice for female patients.
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10
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Inflammation and TGF-β Signaling Differ between Abdominal Aneurysms and Occlusive Disease. J Cardiovasc Dev Dis 2019; 6:jcdd6040038. [PMID: 31683995 PMCID: PMC6955744 DOI: 10.3390/jcdd6040038] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Revised: 10/17/2019] [Accepted: 10/29/2019] [Indexed: 02/07/2023] Open
Abstract
Abdominal aortic aneurysms (AAA), are usually asymptomatic until rupture causes fatal bleeding, posing a major vascular health problem. AAAs are associated with advanced age, male gender, and cardiovascular risk factors (e.g. hypertension and smoking). Strikingly, AAA and AOD (arterial occlusive disease) patients have a similar atherosclerotic burden, yet develop either arterial dilatation or occlusion, respectively. The molecular mechanisms underlying this diversion are yet unknown. As this knowledge could improve AAA treatment strategies, we aimed to identify genes and signaling pathways involved. We compared RNA expression profiles of abdominal aortic AAA and AOD patient samples. Based on differential gene expression profiles, we selected a gene set that could serve as blood biomarker or as pharmacological intervention target for AAA. In this AAA gene list we identified previously AAA-associated genes COL11A1, ADIPOQ, and LPL, thus validating our approach as well as novel genes; CXCL13, SLC7A5, FDC-SP not previously linked to aneurysmal disease. Pathway analysis revealed overrepresentation of significantly altered immune-related pathways between AAA and AOD. Additionally, we found bone morphogenetic protein (BMP) signaling inhibition simultaneous with activation of transforming growth factor β (TGF-β) signaling associated with AAA. Concluding our gene expression profiling approach identifies novel genes and an interplay between BMP and TGF-β signaling regulation specifically for AAA.
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11
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Quintana MJ, Gich I, Librero J, Bellmunt-Montoya S, Escudero JR, Bonfill X. Variation in the choice of elective surgical procedure for abdominal aortic aneurysm in Spain. Vasc Health Risk Manag 2019; 15:69-79. [PMID: 31040686 PMCID: PMC6459220 DOI: 10.2147/vhrm.s191451] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Objective The two main surgical treatments for abdominal aortic aneurysm (AAA) are open surgical repair (OSR) and endovascular aneurysm repair (EVAR). The aim of this study was to analyze variation among Spanish hospitals in the use of OSR or EVAR for AAA. A secondary aim was to assess changes in preferences for these two procedures over time. Methods This was a retrospective longitudinal study based on discharge data from public hospitals in Spain during 2002–2012. Patient inclusion criteria were: age >18 years, elective admission, primary diagnosis of unruptured AAA, and surgical treatment with OSR or EVAR. The characteristics of the treating center, patients, and in-hospital mortality were recorded. Results We included 16,737 patients from 114 hospitals; 6,809 (40.7%) underwent EVAR and 9,928 (59.3%) underwent OSR. The total volume of surgeries increased throughout the period, and the probability that any given procedure was EVAR increased by 20% per year (OR 1.20, P<0.001). The volume and distribution of the two procedures varied highly across the participating hospitals. Overall, in-hospital mortality rate was 3.6% and it decreased during the study period (5.3% in 2002 and 3.2% in 2012), mainly due to a decrease in OSR-related mortality, despite a slight increase in EVAR-related mortality. Hospitals with higher surgical volumes were more likely to use EVAR and have lower in-hospital mortality rates. Conclusion This study reveals high variability in the surgical treatment of unruptured AAA across Spanish hospitals. The number of interventions has increased in recent years, with EVAR accounting for a growing percentage of these surgical procedures. Overall in-hospital mortality rates decreased significantly during this period, mainly due to lower mortality among patients undergoing OSR. In-hospital mortality rates were lower in higher-volume centers, regardless of the surgical approach used. Further research on variability and appropriateness of surgical management of AAA is required to assess the suitability of concentrating elective AAA repair in more experienced centers to potentially achieve better outcomes.
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Affiliation(s)
- M Jesús Quintana
- Department of Clinical Epidemiology and Public Health, University Hospital de la Santa Creu i Sant Pau (IIB Sant Pau), Barcelona, Spain, .,CIBER of Epidemiology and Public Health (CIBERESP), Barcelona, Spain,
| | - Ignasi Gich
- Department of Clinical Epidemiology and Public Health, University Hospital de la Santa Creu i Sant Pau (IIB Sant Pau), Barcelona, Spain, .,CIBER of Epidemiology and Public Health (CIBERESP), Barcelona, Spain, .,Universitat Autònoma de Barcelona, Barcelona, Spain,
| | - Julián Librero
- Navarrabiomed-UPNA -Departamento de Salud, IDISNA, Pamplona, Spain.,Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Bilbao, Spain
| | - Sergi Bellmunt-Montoya
- Department of Angiology, Vascular and Endovascular Surgery, Vall d'Hebron University Hospital, Barcelona, Spain.,Vall d'Hebron Research Institute (VHIR), Barcelona, Spain
| | - José R Escudero
- Universitat Autònoma de Barcelona, Barcelona, Spain, .,Joint Service of Angiology, Vascular and Endovascular Surgery, Sant Pau-Dos de Maig Hospital, Barcelona, Spain.,CIBER Cardiovascular Diseases (CIBERCV), Barcelona, Spain
| | - Xavier Bonfill
- Department of Clinical Epidemiology and Public Health, University Hospital de la Santa Creu i Sant Pau (IIB Sant Pau), Barcelona, Spain, .,CIBER of Epidemiology and Public Health (CIBERESP), Barcelona, Spain, .,Universitat Autònoma de Barcelona, Barcelona, Spain, .,Iberoamerican Cochrane Centre, Barcelona, Spain,
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Thompson SG, Bown MJ, Glover MJ, Jones E, Masconi KL, Michaels JA, Powell JT, Ulug P, Sweeting MJ. Screening women aged 65 years or over for abdominal aortic aneurysm: a modelling study and health economic evaluation. Health Technol Assess 2019; 22:1-142. [PMID: 30132754 DOI: 10.3310/hta22430] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Abdominal aortic aneurysm (AAA) screening programmes have been established for men in the UK to reduce deaths from AAA rupture. Whether or not screening should be extended to women is uncertain. OBJECTIVE To evaluate the cost-effectiveness of population screening for AAAs in women and compare a range of screening options. DESIGN A discrete event simulation (DES) model was developed to provide a clinically realistic model of screening, surveillance, and elective and emergency AAA repair operations. Input parameters specifically for women were employed. The model was run for 10 million women, with parameter uncertainty addressed by probabilistic and deterministic sensitivity analyses. SETTING Population screening in the UK. PARTICIPANTS Women aged ≥ 65 years, followed up to the age of 95 years. INTERVENTIONS Invitation to ultrasound screening, followed by surveillance for small AAAs and elective surgical repair for large AAAs. MAIN OUTCOME MEASURES Number of operations undertaken, AAA-related mortality, quality-adjusted life-years (QALYs), NHS costs and cost-effectiveness with annual discounting. DATA SOURCES AAA surveillance data, National Vascular Registry, Hospital Episode Statistics, trials of elective and emergency AAA surgery, and the NHS Abdominal Aortic Aneurysm Screening Programme (NAAASP). REVIEW METHODS Systematic reviews of AAA prevalence and, for elective operations, suitability for endovascular aneurysm repair, non-intervention rates, operative mortality and literature reviews for other parameters. RESULTS The prevalence of AAAs (aortic diameter of ≥ 3.0 cm) was estimated as 0.43% in women aged 65 years and 1.15% at age 75 years. The corresponding attendance rates following invitation to screening were estimated as 73% and 62%, respectively. The base-case model adopted the same age at screening (65 years), definition of an AAA (diameter of ≥ 3.0 cm), surveillance intervals (1 year for AAAs with diameter of 3.0-4.4 cm, 3 months for AAAs with diameter of 4.5-5.4 cm) and AAA diameter for consideration of surgery (5.5 cm) as in NAAASP for men. Per woman invited to screening, the estimated gain in QALYs was 0.00110, and the incremental cost was £33.99. This gave an incremental cost-effectiveness ratio (ICER) of £31,000 per QALY gained. The corresponding incremental net monetary benefit at a threshold of £20,000 per QALY gained was -£12.03 (95% uncertainty interval -£27.88 to £22.12). Almost no sensitivity analyses brought the ICER below £20,000 per QALY gained; an exception was doubling the AAA prevalence to 0.86%, which resulted in an ICER of £13,000. Alternative screening options (increasing the screening age to 70 years, lowering the threshold for considering surgery to diameters of 5.0 cm or 4.5 cm, lowering the diameter defining an AAA in women to 2.5 cm and lengthening the surveillance intervals for the smallest AAAs) did not bring the ICER below £20,000 per QALY gained when considered either singly or in combination. LIMITATIONS The model for women was not directly validated against empirical data. Some parameters were poorly estimated, potentially lacking relevance or unavailable for women. CONCLUSION The accepted criteria for a population-based AAA screening programme in women are not currently met. FUTURE WORK A large-scale study is needed of the exact aortic size distribution for women screened at relevant ages. The DES model can be adapted to evaluate screening options in men. STUDY REGISTRATION This study is registered as PROSPERO CRD42015020444 and CRD42016043227. FUNDING The National Institute for Health Research Health Technology Assessment programme.
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Affiliation(s)
- Simon G Thompson
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Matthew J Bown
- Department of Cardiovascular Sciences and National Institute of Health Research (NIHR) Leicester Biomedical Research Unit, University of Leicester, Leicester, UK
| | - Matthew J Glover
- Health Economics Research Group, Brunel University London, London, UK
| | - Edmund Jones
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Katya L Masconi
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Jonathan A Michaels
- Health Economics and Decision Science, University of Sheffield, Sheffield, UK
| | - Janet T Powell
- Vascular Surgery Research Group, Imperial College London, London, UK
| | - Pinar Ulug
- Vascular Surgery Research Group, Imperial College London, London, UK
| | - Michael J Sweeting
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
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Abdominal Aortic Aneurysm Screening: A Systematic Review and Meta-analysis of Efficacy and Cost. Ann Vasc Surg 2019; 54:298-303.e3. [DOI: 10.1016/j.avsg.2018.05.044] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Revised: 05/05/2018] [Accepted: 05/15/2018] [Indexed: 02/07/2023]
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14
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Cornejo Saucedo M, García-Gil D, Brun Romero F, Torres do Rego A, Beltrán Romero L, Rodilla Sala E, Acosta Guerra G, Villanueva Martínez J, Casas Rojo J, Torres Macho J, García de Casasola-Sánchez G. Prevalence of abdominal aortic aneurysm in patients with high cardiovascular risk. Rev Clin Esp 2018. [DOI: 10.1016/j.rceng.2018.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Cornejo Saucedo M, García-Gil D, Brun Romero F, Torres do Rego A, Beltrán Romero L, Rodilla Sala E, Acosta Guerra G, Villanueva Martínez J, Casas Rojo J, Torres Macho J, García de Casasola-Sánchez G. Prevalencia de aneurisma de aorta abdominal en pacientes con alto riesgo cardiovascular. Rev Clin Esp 2018; 218:461-467. [DOI: 10.1016/j.rce.2018.08.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2018] [Revised: 07/17/2018] [Accepted: 08/10/2018] [Indexed: 01/27/2023]
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16
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17
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Kebed DT, Bois JP, Connolly HM, Scott CG, Bowen JM, Warrington KJ, Makol A, Greason KL, Schaff HV, Anavekar NS. Spectrum of Aortic Disease in the Giant Cell Arteritis Population. Am J Cardiol 2018; 121:501-508. [PMID: 29291886 DOI: 10.1016/j.amjcard.2017.11.011] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Revised: 11/01/2017] [Accepted: 11/07/2017] [Indexed: 01/12/2023]
Abstract
We report the spectrum of aortic involvement in patients with giant cell arteritis (GCA) following review of medical records of 4,006 patients including those with imaging studies. A total of 1,450 patients (36%) had a confirmed diagnosis of GCA. Of these, 974 had aortic imaging. Of the 974 patients with imaging, 435 (45%) had an identified aortopathy. The most common aortopathy was aneurysm/dilation (69%). Overall, an annual aneurysmal growth rate of 1.5 mm/y was calculated. In patients with aneurysm/dilation, aortic dissection occurred in 18 patients (6%), and these patients had a significantly higher aneurysmal growth rate compared with those without dissection (4.5 vs 1.4 mm/y, p = 0.005). The median size of the aorta at the time of dissection was 51 mm, with 7 (39%) occurring with a maximal aortic aneurysm/dilation <50 mm. In conclusion, our findings indicate higher aneurysmal growth rate in GCA compared with that reported for degenerative aortic disease. Moreover, patients who develop dissection had a significantly higher growth rate than those without dissection with over a third of these patients suffering dissection at a caliber <50 mm.
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Affiliation(s)
- Daniel T Kebed
- Rush University Medical Center, Department of Internal Medicine, Chicago, Illinois
| | - John P Bois
- Mayo Clinic Rochester, Division of Cardiovascular Disease, Rochester, Minnesota
| | - Heidi M Connolly
- Mayo Clinic Rochester, Division of Cardiovascular Disease, Rochester, Minnesota
| | - Christopher G Scott
- Mayo Clinic Rochester, Department of Biomedical Statistics and Informatics, Rochester, Minnesota
| | - Juan M Bowen
- Mayo Clinic Rochester, Division of Primary Care Internal Medicine, Rochester, Minnesota
| | | | - Ashima Makol
- Mayo Clinic Rochester, Division of Rheumatogy, Rochester, Minnesota
| | - Kevin L Greason
- Mayo Clinic Rochester, Division of Cardiovascular Surgery, Rochester, Minnesota
| | - Hartzell V Schaff
- Mayo Clinic Rochester, Division of Cardiovascular Surgery, Rochester, Minnesota
| | - Nandan S Anavekar
- Mayo Clinic Rochester, Division of Cardiovascular Disease, Rochester, Minnesota.
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18
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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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19
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Shen YH, LeMaire SA. Molecular pathogenesis of genetic and sporadic aortic aneurysms and dissections. Curr Probl Surg 2017; 54:95-155. [PMID: 28521856 DOI: 10.1067/j.cpsurg.2017.01.001] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2016] [Accepted: 01/16/2017] [Indexed: 12/20/2022]
Affiliation(s)
- Ying H Shen
- Division of Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX; Department of Cardiovascular Surgery, Texas Heart Institute, Houston, TX; Cardiovascular Research Institute, Baylor College of Medicine, Houston, TX.
| | - Scott A LeMaire
- Division of Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX; Department of Cardiovascular Surgery, Texas Heart Institute, Houston, TX; Cardiovascular Research Institute, Baylor College of Medicine, Houston, TX; Department of Molecular Physiology and Biophysics, Baylor College of Medicine, Houston, TX.
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20
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Castro‐Ferreira R, Mendes P, Couto P, Barreira R, Peixoto F, Aguiar M, Neto M, Rolim D, Pinto J, Freitas A, Gonçalves Dias P, Moreira Sampaio S, Leite‐Moreira A, Mansilha A, Teixeira JF. Rastreio populacional de aneurisma da aorta abdominal em Portugal – o imperativo da sua realização. ANGIOLOGIA E CIRURGIA VASCULAR 2016. [DOI: 10.1016/j.ancv.2016.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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21
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Abstract
The 2014 United States Preventive Services Task Force systematic review found abdominal aortic aneurysm (AAA) screening decreased related mortality by close to half. Despite the simplicity of screening, research suggests poor adherence to the recommended AAA screening guidelines. Using the quality improvement plan-study-do-act cycle, we retrospectively established poor adherence to AAA screening and poor documentation of smoking history in our resident clinic. An electronic reminder was prospectively implemented into our electronic medical record (EMR) with the goal of improving screening rates. After 1 year, a retrospective chart review was conducted. Comparisons of the pre- and post-electronic reminder intervention data were made using chi-square tests and odds ratios (OR). The purposeful AAA screening rate improved 27.8% during the intervention, 40.3% (95% confidence interval [CI]: 28.6-52.0%) versus 12.5% (95% CI: 3.1-21.9%), p = .002, suggesting patients were more likely to be screened as a result of the electronic reminder, OR = 4.73 (95% CI: 1.77-12.65). This improvement translates to a large effect size, Cohen's d = 0.86 (95% CI: 0.31-1.40). Electronic reminders are a simple EMR addition that can provide evidence-based education while improving adherence rates with preventive health screening measures.
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22
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Kim LG, Thompson SG, Marteau TM, Scott RAP. Screening for Abdominal Aortic Aneurysms: The Effects of Age and Social Deprivation on Screening Uptake, Prevalence and Attendance at Follow-Up in the MASS Trial. J Med Screen 2016; 11:50-3. [PMID: 15006116 DOI: 10.1177/096914130301100112] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objectives/setting: The effectiveness of screening programmes may be improved by knowledge of factors affecting screening uptake, disease prevalence and attendance for follow-up. Data from the Multicentre Aneurysm Screening Study (MASS) are used to examine the influences of age and social deprivation in the context of screening for abdominal aortic aneurysms (AAAs). Methods: In the MASS trial, a population-based sample of 34,000 men aged 65 to 74 received an invitation to screening. The associations of attendance at screening with age, social deprivation and season of the year when invited to attend were investigated using logistic regression analysis. Similar analyses were performed for AAA prevalence and attendance at recall scans. Results: Compared with men aged 65–69, those aged 70–74 were less likely to attend screening (79% vs 81 %), had increased prevalence of AAA (6% vs 4%) and were less likely to attend for followup (79% vs 84%). Compared with those in the least deprived quartile, those in the most deprived quartile also were less likely to attend (75% vs 85%), had increased prevalence (6% vs 4%) and were less likely to attend for follow-up (80% vs 83%). Season showed no significant association with attendance at initial screening. Conclusions: Higher age and social deprivation are associated with both poorer attendance at screening and follow-up, and having an AAA. This highlights the importance of promoting screening programmes, particularly to the more deprived populations.
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Affiliation(s)
- L G Kim
- MRC Biostatistics Unit, Institute of Public Health, University Forvie Site, Robinson Way, Cambridge CB2 2SR, UK.
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23
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Zarrouk M, Lundqvist A, Holst J, Troëng T, Gottsäter A. Cost-effectiveness of Screening for Abdominal Aortic Aneurysm in Combination with Medical Intervention in Patients with Small Aneurysms. Eur J Vasc Endovasc Surg 2016; 51:766-73. [PMID: 26952345 DOI: 10.1016/j.ejvs.2015.12.048] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2015] [Accepted: 12/31/2015] [Indexed: 01/16/2023]
Abstract
OBJECTIVES Screening for abdominal aortic aneurysm (AAA) among 65 year old men has been proven cost-effective, but nowadays is conducted partly under new conditions. The prevalence of AAA has decreased, and endovascular aneurysm repair (EVAR) has become the predominant surgical method for AAA repair in many centers. At the Malmö Vascular Center pharmacological secondary prevention with statins, antiplatelet therapy, and blood pressure reduction is initiated and given to all patients with AAA. This study evaluates the cost-effectiveness of AAA screening under the above mentioned conditions. METHODS This was a Markov cohort simulation. A total of 4,300 65 year old men were invited to annual AAA screening; the attendance rate was 78.3% and AAA prevalence was 1.8%. A Markov model with 11 health states was used to evaluate cost-effectiveness of AAA screening. Background data on rupture risks, costs, and effectiveness of surgical interventions were obtained from the participating unit, the national Swedvasc Registry, and from the scientific literature. RESULTS The additional costs of the screening strategy compared with no screening were €169 per person and year. The incremental health gain per subject in the screened cohort was 0.011 additional quality adjusted life years (QALYs), corresponding to an incremental cost-effectiveness ratio (ICER) of €15710 per QALY. Assuming a 10% reduction of all cause mortality, the incremental cost of screening was €175 per person and year. The gain per subject in the screened cohort was 0.013 additional QALYs, corresponding to an ICER of €13922 per QALY CONCLUSIONS: AAA screening remains cost-effective according to both the Swedish recommendations and the UK National Institute for Health and Care Excellence recommendations in the new era of lower AAA prevalence, EVAR as the predominant surgical method, and secondary prevention for all AAA patients.
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Affiliation(s)
- M Zarrouk
- Department of Vascular Diseases, Skåne University Hospital, Malmö, Sweden.
| | - A Lundqvist
- Swedish Institute for Health Economics, IHE, Lund, Sweden
| | - J Holst
- Department of Vascular Diseases, Skåne University Hospital, Malmö, Sweden
| | - T Troëng
- Department of Surgical Sciences, Vascular Surgery, Uppsala University, Uppsala, Sweden
| | - A Gottsäter
- Department of Vascular Diseases, Skåne University Hospital, Malmö, Sweden
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24
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Lahoz C, Gracia CE, García LR, Montoya SB, Hernando ÁB, Heredero ÁF, Tembra MS, Velasco MB, Guijarro C, Ruiz EB, Pintó X, de Ceniga MV, Moñux Ducajú G. [Not Available]. CLINICA E INVESTIGACION EN ARTERIOSCLEROSIS : PUBLICACION OFICIAL DE LA SOCIEDAD ESPANOLA DE ARTERIOSCLEROSIS 2016; 28 Suppl 1:1-49. [PMID: 27107212 DOI: 10.1016/s0214-9168(16)30026-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Affiliation(s)
- Carlos Lahoz
- Unidad de Lípidos y Riesgo Vascular, Servicio de Medicina Interna, Hospital Carlos III, Madrid, España.
| | - Carlos Esteban Gracia
- Servicio de Angiología y Cirugía Vascular, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, España
| | | | - Sergi Bellmunt Montoya
- Servicio de Angiología y Cirugía Vascular, Hospital de la Santa Creu i Sant Pau, Barcelona, España
| | - Ángel Brea Hernando
- Unidad de Lípidos, Servicio de Medicina Interna, Hospital San Pedro, Logroño, España
| | | | - Manuel Suárez Tembra
- Unidad de Lípidos y Riesgo Cardiovascular, Servicio de Medicina Interna, Hospital San Rafael, A Coruña, España
| | - Marta Botas Velasco
- Servicio de Angiología y Cirugía Vascular, Hospital de Cabueñes, Gijón, España
| | - Carlos Guijarro
- Consulta de Riesgo Vascular, Unidad de Medicina Interna, Hospital Universitario Fundación Alcorcón, Alcorcón, Madrid, España
| | - Esther Bravo Ruiz
- Servicio de Angiología y Cirugía Vascular, Hospital Universitario de Basurto, Bilbao, España
| | - Xavier Pintó
- Unidad de Riesgo Vascular, Servicio de Medicina Interna, Hospital Universitario de Bellvitge, L' Hospitalet de Llobregat, Barcelona, España
| | - Melina Vega de Ceniga
- Servicio de Angiología y Cirugía Vascular, Hospital de Galdakao-Usansolo, Vizcaya, España
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25
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Zhang J, Zhao X, Vatner DE, McNulty T, Bishop S, Sun Z, Shen YT, Chen L, Meininger GA, Vatner SF. Extracellular Matrix Disarray as a Mechanism for Greater Abdominal Versus Thoracic Aortic Stiffness With Aging in Primates. Arterioscler Thromb Vasc Biol 2016; 36:700-6. [PMID: 26891739 DOI: 10.1161/atvbaha.115.306563] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2015] [Accepted: 02/08/2016] [Indexed: 01/08/2023]
Abstract
OBJECTIVE Increased vascular stiffness is central to the pathophysiology of aging, hypertension, diabetes mellitus, and atherosclerosis. However, relatively few studies have examined vascular stiffness in both the thoracic and the abdominal aorta with aging, despite major differences in anatomy, embryological origin, and relation to aortic aneurysm. APPROACH AND RESULTS The 2 other unique features of this study were (1) to study young (9±1 years) and old (26±1 years) male monkeys and (2) to study direct and continuous measurements of aortic pressure and thoracic and abdominal aortic diameters in conscious monkeys. As expected, aortic stiffness, β, was increased P<0.05, 2- to 3-fold, in old versus young thoracic aorta and augmented further with superimposition of acute hypertension with phenylephrine. Surprisingly, stiffness was not greater in old thoracic aorta than in young abdominal aorta. These results can be explained, in part, by the collagen/elastin ratio, but more importantly, by disarray of collagen and elastin, which correlated best with vascular stiffness. However, vascular smooth muscle cell stiffness was not different in thoracic versus abdominal aorta in either young or old monkeys. CONCLUSIONS Thus, aortic stiffness increases with aging as expected, but the most severe increases in aortic stiffness observed in the abdominal aorta is novel, where values in young monkeys equaled, or even exceeded, values of thoracic aortic stiffness in old monkeys. These results can be explained by alterations in collagen/elastin ratio, but even more importantly by collagen and elastin disarray.
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Affiliation(s)
- Jie Zhang
- From the Department of Cell Biology and Molecular Medicine, Rutgers-New Jersey Medical School, Cardiovascular Research Institute, Newark (J.Z., X.Z., D.E.V., T.M.N., S.B., Y.-T.S., L.C., S.F.V.); and Department of Medical Pharmacology and Physiology, Dalton Cardiovascular Research Center, University of Missouri, Columbia (Z.S., G.A.M.)
| | - Xin Zhao
- From the Department of Cell Biology and Molecular Medicine, Rutgers-New Jersey Medical School, Cardiovascular Research Institute, Newark (J.Z., X.Z., D.E.V., T.M.N., S.B., Y.-T.S., L.C., S.F.V.); and Department of Medical Pharmacology and Physiology, Dalton Cardiovascular Research Center, University of Missouri, Columbia (Z.S., G.A.M.)
| | - Dorothy E Vatner
- From the Department of Cell Biology and Molecular Medicine, Rutgers-New Jersey Medical School, Cardiovascular Research Institute, Newark (J.Z., X.Z., D.E.V., T.M.N., S.B., Y.-T.S., L.C., S.F.V.); and Department of Medical Pharmacology and Physiology, Dalton Cardiovascular Research Center, University of Missouri, Columbia (Z.S., G.A.M.)
| | - Tara McNulty
- From the Department of Cell Biology and Molecular Medicine, Rutgers-New Jersey Medical School, Cardiovascular Research Institute, Newark (J.Z., X.Z., D.E.V., T.M.N., S.B., Y.-T.S., L.C., S.F.V.); and Department of Medical Pharmacology and Physiology, Dalton Cardiovascular Research Center, University of Missouri, Columbia (Z.S., G.A.M.)
| | - Sanford Bishop
- From the Department of Cell Biology and Molecular Medicine, Rutgers-New Jersey Medical School, Cardiovascular Research Institute, Newark (J.Z., X.Z., D.E.V., T.M.N., S.B., Y.-T.S., L.C., S.F.V.); and Department of Medical Pharmacology and Physiology, Dalton Cardiovascular Research Center, University of Missouri, Columbia (Z.S., G.A.M.)
| | - Zhe Sun
- From the Department of Cell Biology and Molecular Medicine, Rutgers-New Jersey Medical School, Cardiovascular Research Institute, Newark (J.Z., X.Z., D.E.V., T.M.N., S.B., Y.-T.S., L.C., S.F.V.); and Department of Medical Pharmacology and Physiology, Dalton Cardiovascular Research Center, University of Missouri, Columbia (Z.S., G.A.M.)
| | - You-Tang Shen
- From the Department of Cell Biology and Molecular Medicine, Rutgers-New Jersey Medical School, Cardiovascular Research Institute, Newark (J.Z., X.Z., D.E.V., T.M.N., S.B., Y.-T.S., L.C., S.F.V.); and Department of Medical Pharmacology and Physiology, Dalton Cardiovascular Research Center, University of Missouri, Columbia (Z.S., G.A.M.)
| | - Li Chen
- From the Department of Cell Biology and Molecular Medicine, Rutgers-New Jersey Medical School, Cardiovascular Research Institute, Newark (J.Z., X.Z., D.E.V., T.M.N., S.B., Y.-T.S., L.C., S.F.V.); and Department of Medical Pharmacology and Physiology, Dalton Cardiovascular Research Center, University of Missouri, Columbia (Z.S., G.A.M.)
| | - Gerald A Meininger
- From the Department of Cell Biology and Molecular Medicine, Rutgers-New Jersey Medical School, Cardiovascular Research Institute, Newark (J.Z., X.Z., D.E.V., T.M.N., S.B., Y.-T.S., L.C., S.F.V.); and Department of Medical Pharmacology and Physiology, Dalton Cardiovascular Research Center, University of Missouri, Columbia (Z.S., G.A.M.)
| | - Stephen F Vatner
- From the Department of Cell Biology and Molecular Medicine, Rutgers-New Jersey Medical School, Cardiovascular Research Institute, Newark (J.Z., X.Z., D.E.V., T.M.N., S.B., Y.-T.S., L.C., S.F.V.); and Department of Medical Pharmacology and Physiology, Dalton Cardiovascular Research Center, University of Missouri, Columbia (Z.S., G.A.M.).
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Lee SS, Joh JH. Case study of abdominal aortic aneurysm screening programs in other countries and feasibility study of a national screening program for South Korea. JOURNAL OF THE KOREAN MEDICAL ASSOCIATION 2016. [DOI: 10.5124/jkma.2016.59.10.804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Sang-Soo Lee
- Seoul School of Integrated Sciences & Technologies, Seoul, Korea
| | - Jin Hyun Joh
- Division of Vascular & Endovascular Surgery, Department of Surgery, Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine, Seoul, Korea
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27
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Rueda Martínez de Santos JR. [Economic evaluation studies in diagnostic imaging: justification and critical reading]. RADIOLOGIA 2015; 57 Suppl 2:10-22. [PMID: 26563613 DOI: 10.1016/j.rx.2015.09.003] [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: 03/16/2015] [Revised: 08/19/2015] [Accepted: 09/14/2015] [Indexed: 10/22/2022]
Abstract
First, this article describes the concepts and tools most widely used for economic evaluation in healthcare. Second, it discusses some elements that must be taken into account in the social decision about how much we are willing to spend to prolong a person's life by one year. Third, it describes the criteria recommended for the critical analysis of publications that evaluate the economic aspects of health interventions. Finally, several studies about ultrasound screening for aneurysms of the abdominal aorta are used as illustrative examples to show how these elements and criteria can be applied.
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Abstract
Population screening programmes and a falling population prevalence of smoking have led to a declining incidence of ruptured abdominal aortic aneurysms in men. However, ruptured abdominal aortic aneurysms remain a common vascular surgical emergency, with an increasing proportion of ruptures being in women. About one quarter of the ruptures have a juxta-renal aneurysm and are more challenging to repair using endovascular technologies. Endovascular technologies may not reduce the overall mortality, compared with open surgical repair, but appear to offer early benefits with respect to patient quality of life at acceptable cost. Challenges over the next 5 years include widening the access to repair, developing an accurate bedside risk scoring tool, as well as optimising strategies for pre-operative resuscitation, standardising peri-operative care and the management of post-operative complications.
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Affiliation(s)
- Janet T Powell
- a St George's Vascular Institute , St George's Hospital , London , UK
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29
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30
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Flessenkaemper IH, Loddenkemper R, Roll S, Enke-Melzer K, Wurps H, Bauer TT. Screening of COPD patients for abdominal aortic aneurysm. Int J Chron Obstruct Pulmon Dis 2015; 10:1085-91. [PMID: 26089658 PMCID: PMC4468935 DOI: 10.2147/copd.s81439] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Purpose Screening for abdominal aortic aneurysm (AAA) in “men aged over 65 years who have ever smoked” is a recommended policy. To reduce the number of screenings, it may be of value to define subgroups with a higher prevalence of AAA. Since chronic obstructive pulmonary disease (COPD) and AAA are associated with several common risk factors, this study investigates the prevalence of AAA in COPD patients. Patients and methods Patients with COPD were identified via the hospital information system. Inclusion criteria were: COPD stage I–IV, ability to give full consent, and age >18 years; exclusion criteria were: patient too obese for an ultrasound check, previously diagnosed AAA, prior surgery for AAA, or ethical grounds such as concomitant advanced malignant or end-stage disease. The primary endpoint of the study was an aortic diameter measured by ultrasound of ≥30 mm. Defined secondary endpoints were evaluated on the basis of medical records and interviews. Results Of the 1,180 identified COPD patients, 589 were included in this prospective study. In 22 patients (3.70%), the aortic diameter was ≥30 mm, representing an AAA prevalence of 6.72% among males aged >65 years. The risk of AAA increased with the following comorbidities/risk factors: male sex (odds ratio [OR] 2.98), coronary heart disease (OR 2.81), peripheral arterial occlusive disease (OR 2.47), hyperlipoproteinemia (OR 2.77), AAA in the family history (OR 3.95), and COPD stage I/II versus IV (OR 1.81). Conclusion The overall AAA prevalence of 3.7% in our group of COPD patients is similar to that of the general population aged >65 years. However, the frequency of AAA in male COPD patients aged >65 years is considerably higher (6.72%) and increased further still in those individuals with additional comorbidities/risk factors. Defining subgroups with a higher risk of AAA may increase the efficiency of screening.
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Affiliation(s)
| | | | - Stephanie Roll
- Institute for Social Medicine, Epidemiology and Health Economics, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Kathrin Enke-Melzer
- Department for Vascular Medicine, Helios Klinikum Emil von Behring, Berlin, Germany
| | - Henrik Wurps
- Department of Pneumology, Helios Klinikum Emil von Behring, Berlin, Germany
| | - Torsten T Bauer
- Department of Pneumology, Helios Klinikum Emil von Behring, Berlin, Germany
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31
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Hanney SR, González-Block MA. Health research improves healthcare: now we have the evidence and the chance to help the WHO spread such benefits globally. Health Res Policy Syst 2015; 13:12. [PMID: 25888723 PMCID: PMC4351695 DOI: 10.1186/s12961-015-0006-y] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2015] [Accepted: 02/20/2015] [Indexed: 12/13/2022] Open
Abstract
There has been a dramatic increase in the body of evidence demonstrating the benefits that come from health research. In 2014, the funding bodies for higher education in the UK conducted an assessment of research using an approach termed the Research Excellence Framework (REF). As one element of the REF, universities and medical schools in the UK submitted 1,621 case studies claiming to show the impact of their health and other life sciences research conducted over the last 20 years. The recently published results show many case studies were judged positively as providing examples of the wide range and extensive nature of the benefits from such research, including the development of new treatments and screening programmes that resulted in considerable reductions in mortality and morbidity. Analysis of specific case studies yet again illustrates the international dimension of progress in health research; however, as has also long been argued, not all populations fully share the benefits. In recognition of this, in May 2013 the World Health Assembly requested the World Health Organization (WHO) to establish a Global Observatory on Health Research and Development (R&D) as part of a strategic work-plan to promote innovation, build capacity, improve access, and mobilise resources to address diseases that disproportionately affect the world’s poorest countries. As editors of Health Research Policy and Systems (HARPS), we are delighted that our journal has been invited to help inform the establishment of the WHO Global Observatory through a Call for Papers covering a range of topics relevant to the Observatory, including topics on which HARPS has published articles over the last few months, such as approaches to assessing research results, measuring expenditure data with a focus on R&D, and landscape analyses of platforms for implementing R&D. Topics related to research capacity building may also be considered. The task of establishing a Global Observatory on Health R&D to achieve the specified objectives will not be easy; nevertheless, this Call for Papers is well timed – it comes just at the point where the evidence of the benefits from health research has been considerably strengthened.
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Affiliation(s)
- Stephen R Hanney
- Health Economics Research Group, Brunel University London, Kingston Lane, Uxbridge, UB8 3PH, UK.
| | - Miguel A González-Block
- Universidad Anáhuac, Av. Universidad Anáhuac 46, Lomas Anáhuac, 52786 Huixquilucan, Mexico City, Mexico.
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Svensjö S, Björck M, Wanhainen A. Update on Screening for Abdominal Aortic Aneurysm: A Topical Review. Eur J Vasc Endovasc Surg 2014; 48:659-67. [DOI: 10.1016/j.ejvs.2014.08.029] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2014] [Accepted: 08/31/2014] [Indexed: 11/30/2022]
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Olchanski N, Winn A, Cohen JT, Neumann PJ. Abdominal aortic aneurysm screening: how many life years lost from underuse of the medicare screening benefit? J Gen Intern Med 2014; 29:1155-61. [PMID: 24715406 PMCID: PMC4099445 DOI: 10.1007/s11606-014-2831-z] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2013] [Revised: 11/25/2013] [Accepted: 03/02/2014] [Indexed: 11/29/2022]
Abstract
BACKGROUND Since 2007, Medicare has provided one-time abdominal aortic aneurysm (AAA) screening for men with smoking history, and men and women with a family history of AAA as part of its Welcome to Medicare visit. OBJECTIVE We examined utilization of the new AAA screening benefit and estimated how increased utilization could influence population health as measured by life years gained. Additionally, we explored the impact of expanding screening to women with smoking history. DESIGN Analysis of Medicare claims and a simulation model to estimate the effects of screening, using published data for parameter estimates. SETTING AAA screening in the primary care setting. PATIENTS Newly-enrolled Medicare beneficiaries aged 65 years, with smoking history or family history of AAA. MAIN MEASURES Life expectancy, 10-year survival rates. KEY RESULTS Medicare data revealed low utilization of AAA screening, under 1% among those eligible. We estimate that screening could increase life expectancy per individual invited to screening for men with smoking history (0.11 years), with family history of AAA (0.17 years), and women with family history (0.08 years), and smoking history (0.09 years). Average gains of 131 life years per 1,000 persons screened for AAA compare favorably with the grade B United States Preventive Services Task Force (USPSTF) recommendation for breast cancer screening, which yields 95-128 life years per 1,000 women screened. These findings were robust over a range of scenarios. LIMITATIONS The simulation results reflect assumptions regarding AAA prevalence, treatment, and outcomes in specific populations based on published research and US survey data. Published data on women were limited. CONCLUSIONS The Welcome to Medicare and AAA screening benefits have been underutilized. Increasing utilization of AAA screening would yield substantial gains in life expectancy. Expanding screening to women with smoking history also has the potential for substantial health benefits.
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Affiliation(s)
- N Olchanski
- Center for the Evaluation of Value and Risk in Health, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA, USA,
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Glover MJ, Kim LG, Sweeting MJ, Thompson SG, Buxton MJ. Cost-effectiveness of the National Health Service Abdominal Aortic Aneurysm Screening Programme in England. Br J Surg 2014; 101:976-82. [PMID: 24862963 PMCID: PMC4231222 DOI: 10.1002/bjs.9528] [Citation(s) in RCA: 84] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/07/2014] [Indexed: 11/09/2022]
Abstract
BACKGROUND Implementation of the National Health Service abdominal aortic aneurysm (AAA) screening programme (NAAASP) for men aged 65 years began in England in 2009. An important element of the evidence base supporting its introduction was the economic modelling of the long-term cost-effectiveness of screening, which was based mainly on 4-year follow-up data from the Multicentre Aneurysm Screening Study (MASS) randomized trial. Concern has been expressed about whether this conclusion of cost-effectiveness still holds, given the early performance parameters, particularly the lower prevalence of AAA observed in NAAASP. METHODS The existing published model was adjusted and updated to reflect the current best evidence. It was recalibrated to mirror the 10-year follow-up data from MASS; the main cost parameters were re-estimated to reflect current practice; and more robust estimates of AAA growth and rupture rates from recent meta-analyses were incorporated, as were key parameters as observed in NAAASP (attendance rates, AAA prevalence and size distributions). RESULTS The revised and updated model produced estimates of the long-term incremental cost-effectiveness of £5758 (95 per cent confidence interval £4285 to £7410) per life-year gained, or £7370 (£5467 to £9443) per quality-adjusted life-year (QALY) gained. CONCLUSION Although the updated parameters, particularly the increased costs and lower AAA prevalence, have increased the cost per QALY, the latest modelling provides evidence that AAA screening as now being implemented in England is still highly cost-effective.
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Affiliation(s)
- M J Glover
- Health Economics Research Group, Brunel University, London, UK
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Smith RW, Evans T, Wolstenhulme S. Reliability of aortic aneurysm screening measurements. ULTRASOUND : JOURNAL OF THE BRITISH MEDICAL ULTRASOUND SOCIETY 2014; 22:80-90. [PMID: 27433200 DOI: 10.1177/1742271x13513980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The aim of this feasibility study was to assess the impact that image processing of abdominal aortic ultrasound (US) images had on the intra-observer reliability of the diameter measurement. The study compared variability between inner-to-inner (ITI), outer-to-outer (OTO) and outer-to-inner (OTI) wall diameter measurements and their resilience to image processing. Three US images of transverse abdominal aortas were manipulated in 13 different ways using functions from Image J software (National Institutes of Health, Bethesda, MD, USA). Blinded measurements were performed of the aortic diameters from each image; this was repeated for ITI, OTO and OTI. Profiles of each image were produced and sets of rules developed to provide detailed instructions as to where, on the profile, the callipers should be placed to correspond with the actual image. The reliability of the diameter measurements compared to the original diameter measurement was least affected by adjusting the brightness and contrast of the US images (better than ± 1.5 mm). Using the functions 'Sharpen' and 'Find Edges' created the largest difference (up to -5 mm). The ITI measurements had the widest spread of variability, whereas the OTI measurements proved to be the most repeatable and resilient to image processing. This study suggests the precision of the measurements can be kept within satisfactory levels even after image manipulation. It also showed the most reliable measuring guideline was OTI, in contrast to the guideline currently used by the NHS Abdominal Aortic Aneurysm Screening Programme. Further research is needed to transfer the findings into the clinical setting of the National Screening Programme to increase its reliability.
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Affiliation(s)
| | - Tony Evans
- Department of Medical Physics, University of Leeds, Leeds, UK
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Guessous I, Cornuz J. Abdominal aortic aneurysm screening: 2006 recommendations. Expert Rev Pharmacoecon Outcomes Res 2014; 6:555-61. [DOI: 10.1586/14737167.6.5.555] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Li X, Zhao G, Zhang J, Duan Z, Xin S. Prevalence and trends of the abdominal aortic aneurysms epidemic in general population--a meta-analysis. PLoS One 2013; 8:e81260. [PMID: 24312543 PMCID: PMC3846841 DOI: 10.1371/journal.pone.0081260] [Citation(s) in RCA: 137] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2013] [Accepted: 10/10/2013] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE To conduct a meta-analysis assessing the prevalence and trends of the abdominal aortic aneurysms (AAA) epidemic in general population. METHOD Studies that reported prevalence rates of AAA from the general population were identified through MEDLINE, EMBASE, Web of Science, and reference lists for the period between 1988 and 2013. Studies were included if they reported prevalence rates of AAA in general population from the community. In stratified analyses possible sources of bias, including areas difference, age, gender and diameter of aneurysms were examined. Publication bias was assessed with Egger's test method. RESULTS 56 studies were identified. The overall pooled prevalence of AAA was 4.8% (4.3%, 5.3%). Stratified analyses showed the following results, areas difference: America 2.2% (2.2%, 2.2%), Europe 2.5% (2.4%, 2.5%), Australia 6.7% (6.5%, 7.0%), Asia 0.5% (0.3%, 0.7%); gender difference: male 6.0% (5.3%, 6.7%), female 1.6% (1.2%, 1.9%); age difference: 55-64years 1.3% (1.2%, 1.5%), 65-74 years 2.8% (2.7%, 2.9%), 75-84 years1.2%(1.1%, 1.3%), ≥85years0.6% (0.4%, 0.7%); aortic diameters difference: 30-39 mm, 3.3% (2.8%, 3.9%), 40-49 mm,0.7% (0.4%,1.0%), ≥50 mm, 0.4% (0.3%, 0.5%). The prevalence of AAA has decreased in Europe from 1988 to 2013. Hypertension, smoking, coronary artery disease, dyslipidemia, respiratory disease, cerebrovascular disease, claudication and renal insufficiency were risk factors for AAA in Europe. CONCLUSION AAA is common in general population. The prevalence of AAA is higher in Australia than America and Europe. The pooled prevalence in western countries is higher than the Asia. Future research requires a larger database on the epidemiology of AAA in general population.
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Affiliation(s)
- Xi Li
- Department of Vascular and Thyroid Surgery, the First Affiliated Hospital of China Medical University, Shenyang, China
| | - Ge Zhao
- Department of Obstetrics, Chinese People's Liberation Army 463th Hospital, Shenyang, China
| | - Jian Zhang
- Department of Vascular and Thyroid Surgery, the First Affiliated Hospital of China Medical University, Shenyang, China
| | - Zhiquan Duan
- Department of Vascular and Thyroid Surgery, the First Affiliated Hospital of China Medical University, Shenyang, China
| | - Shijie Xin
- Department of Vascular and Thyroid Surgery, the First Affiliated Hospital of China Medical University, Shenyang, China
- * E-mail:
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Harrison SC, Smith AJ, Jones GT, Swerdlow DI, Rampuri R, Bown MJ, Folkersen L, Baas AF, de Borst GJ, Blankensteijn JD, Price JF, van der Graaf Y, McLachlan S, Agu O, Hofman A, Uitterlinden AG, Franco-Cereceda A, Ruigrok YM, van't Hof F, Powell JT, van Rij AM, Casas JP, Eriksson P, Holmes MV, Asselbergs FW, Hingorani AD, Humphries SE. Interleukin-6 receptor pathways in abdominal aortic aneurysm. Eur Heart J 2013; 34:3707-16. [PMID: 23111417 PMCID: PMC3869968 DOI: 10.1093/eurheartj/ehs354] [Citation(s) in RCA: 120] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2012] [Revised: 08/24/2012] [Accepted: 09/10/2012] [Indexed: 11/25/2022] Open
Abstract
METHODS We conducted a systematic review and meta-analysis of studies reporting circulating IL-6 in AAA, and new investigations of the association between a common non-synonymous functional variant (Asp358Ala) in the IL-6R gene (IL6R) and AAA, followed the analysis of the variant both in vitro and in vivo. Inflammation may play a role in the development of abdominal aortic aneurysms (AAA). Interleukin-6 (IL-6) signalling through its receptor (IL-6R) is one pathway that could be exploited pharmacologically. We investigated this using a Mendelian randomization approach. RESULTS Up to October 2011, we identified seven studies (869 cases, 851 controls). Meta-analysis demonstrated that AAA cases had higher levels of IL-6 than controls [standardized mean difference (SMD) = 0.46 SD, 95% CI = 0.25-0.66, I(2) = 70%, P = 1.1 × 10-5 random effects]. Meta-analysis of five studies (4524 cases/15 710 controls) demonstrated that rs7529229 (which tags the non-synonymous variant Asp358Ala, rs2228145) was associated with a lower risk of AAA, per Ala358 allele odds ratio 0.84, 95% CI: 0.80-0.89, I(2) = 0%, P = 2.7 × 10-11). In vitro analyses in lymphoblastoid cell lines demonstrated a reduction in the expression of downstream targets (STAT3, MYC and ICAM1) in response to IL-6 stimulation in Ala358 carriers. CONCLUSIONS A Mendelian randomization approach provides robust evidence that signalling via the IL-6R is likely to be a causal pathway in AAA. Drugs that inhibit IL-6R may play a role in AAA management.
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Affiliation(s)
- Seamus C. Harrison
- Department of Cardiovascular Genetics,Institute of Cardiovascular Science, University College London, Rayne Building, University Street, London WC1E 6JJ, UK
- BHF Laboratories, Centre for Cardiovascular Genetics, Institute of Cardiovascular Science, University College London (UCL), The Rayne Building, 5 University Street, London WC1E 6JF, UK
| | - Andrew J.P. Smith
- Department of Cardiovascular Genetics,Institute of Cardiovascular Science, University College London, Rayne Building, University Street, London WC1E 6JJ, UK
| | | | | | - Riaz Rampuri
- Department of Cardiovascular Genetics,Institute of Cardiovascular Science, University College London, Rayne Building, University Street, London WC1E 6JJ, UK
| | - Matthew J. Bown
- Department of Cardiovascular Sciences, Leicester University, Leicester LE2 7LX, UK
| | | | - Lasse Folkersen
- Atherosclerosis Research Unit, Department of Medicine Solna, Karolinska Institute, Stockholm 171 76, Sweden
| | - Annette F. Baas
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht 3584CG, The Netherlands
| | - Gert Jan de Borst
- Vascular Surgery, UMC Utrecht, PO Box 85500, G04.129, Utrecht 3508GA, The Netherlands
| | - Jan D. Blankensteijn
- Department of Surgery, Vascular Surgery, VU Medical Center, PO Box 7057 ZH F 018, Amsterdam 1007, The Netherlands
| | - Jacqueline F. Price
- Wolfson Unit for Prevention of Peripheral Vascular Diseases, University of Edinburgh, Teviot Place, Edinburgh EH8 9AG, UK
| | - Yolanda van der Graaf
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht 3584CG, The Netherlands
| | - Stela McLachlan
- Wolfson Unit for Prevention of Peripheral Vascular Diseases, University of Edinburgh, Teviot Place, Edinburgh EH8 9AG, UK
| | - Obi Agu
- Vascular Surgery, University College London Hospital, London NW1 2BU, UK
| | - Albert Hofman
- Department of Epidemiology, Erasmus Medical Center, Rotterdam 3000CA, The Netherlands
| | - Andre G. Uitterlinden
- Department of Epidemiology, Erasmus Medical Center, Rotterdam 3000CA, The Netherlands
| | | | - Ynte M. Ruigrok
- Department of Neurology and Neurosurgery, Rudolf Magnus Institute of Neuroscience, University Medical Center Utrecht, Utrecht 3508 GA, The Netherlands
| | - F.N. van't Hof
- Department of Neurology and Neurosurgery, Rudolf Magnus Institute of Neuroscience, University Medical Center Utrecht, Utrecht 3508 GA, The Netherlands
| | - Janet T. Powell
- Vascular Surgery Research Group, Imperial College Charing Cross Hospital, 4th Floor, Fulham Palace Road, London W6 8RF, UK
| | | | - Juan P. Casas
- London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK
| | - Per Eriksson
- Department of Cardiovascular Sciences, Leicester University, Leicester LE2 7LX, UK
| | - Michael V. Holmes
- Genetic Epidemiology, University College London, London WC1E 6JJ, UK
| | - Folkert W. Asselbergs
- Division Heart and Lungs, Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
- Department of Medical Genetics, Biomedical Genetics, University Medical Center, Utrecht, The Netherlands
| | | | - Steve E. Humphries
- Department of Cardiovascular Genetics,Institute of Cardiovascular Science, University College London, Rayne Building, University Street, London WC1E 6JJ, UK
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Riches K, Angelini TG, Mudhar GS, Kaye J, Clark E, Bailey MA, Sohrabi S, Korossis S, Walker PG, Scott DJA, Porter KE. Exploring smooth muscle phenotype and function in a bioreactor model of abdominal aortic aneurysm. J Transl Med 2013; 11:208. [PMID: 24028184 PMCID: PMC3847145 DOI: 10.1186/1479-5876-11-208] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2013] [Accepted: 09/04/2013] [Indexed: 01/13/2023] Open
Abstract
Background Vascular smooth muscle cells (SMC) are central to arterial structure and function yet their involvement in the progression of abdominal aortic aneurysm (AAA) disease is not well studied. The progressive and silent nature of AAA in man essentially restricts research to the use of “end-stage” tissue recovered during surgical repair. This study aimed to generate an ex vivo model of AAA using protease-treated porcine carotid arteries maintained in a novel bioreactor, and to compare the structural and functional changes in SMC cultured from the recovered vessels with those from human tissue acquired at elective surgical repair. Methods Freshly isolated porcine arteries were pretreated with collagenase and/or elastase before culturing under flow in a bioreactor for 12 days. Human end-stage aneurysmal tissue and saphenous veins from age-matched controls were collected from patients undergoing surgery. SMC were cultured and characterised (immunocytochemistry, measurement of spread cell area) and assessed functionally at the level of proliferation (cell-counting) and matrix-metalloproteinase (MMP) secretion (gelatin zymography). Cellular senescence was investigated using β-galactosidase staining and apoptosis was quantified using a fluorescence-based caspase 3 assay. Results Co-expression of alpha-smooth muscle actin and smooth muscle myosin heavy chain confirmed all cell populations as SMC. Porcine SMC harvested and cultivated after collagenase/elastase pretreatment displayed a prominent “rhomboid” morphology, increased spread area (32%, P < 0.01), impaired proliferation (47% reduction, P < 0.05), increased senescence (52%, P < 0.001), susceptibility to apoptosis and reduced MMP-2 secretion (60% decrease, P < 0.01) compared with SMC from vehicle, collagenase or elastase pre-treated vessels. Notably, these changes were comparable to those observed in human AAA SMC which were 2.4-fold larger than non-aneurysmal SMC (P < 0.001) and exhibited reduced proliferation (39% reduction, P < 0.001), greater apoptosis (4-fold increase, P < 0.001), and increased senescence (61%, P < 0.05). Conclusions Combined collagenase/elastase exposure of porcine artery maintained in a bioreactor under flow conditions induced a SMC phenotype characteristic of those cultured from end-stage AAA specimens. This model has potential and versatility to examine temporal changes in SMC biology and to identify the molecular mechanisms leading to early aberrancies in SMC function. In the longer term this may inform new targets to maintain aortic SMC content and drive cells to a “reparative” phenotype at early stages of the disease.
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Affiliation(s)
- Kirsten Riches
- Division of Cardiovascular and Diabetes Research, Leeds Institute of Genetics, Health and Therapeutics (LIGHT), University of Leeds, Leeds, UK.
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Vranes M, Davidovic L, Vasic D, Radmili O. Coexistence of internal carotid artery stenosis in patients with abdominal aortic aneurysm. Korean Circ J 2013; 43:550-6. [PMID: 24044014 PMCID: PMC3772300 DOI: 10.4070/kcj.2013.43.8.550] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2013] [Revised: 03/08/2013] [Accepted: 07/26/2013] [Indexed: 11/11/2022] Open
Abstract
Background and Objectives Abdominal Aortic Aneurysm (AAA) and carotid disease have medical and social significance, considering their morbidity, disability, and economic consequences. The study objectives were to determine the prevalence of asymptomatic internal carotid artery (ICA) lesions ≥70% in patients with AAA, the correlation of AAA diameter with the degree of ICA stenosis and symptoms, and the importance of preventive ultrasound checkups. Subjects and Methods A prospective non-randomized controlled study including 740 patients, aged from 18-85 years, who were suitable for the inclusion and exclusion criteria and reported at the vascular laboratory of the Institute for Vascular and Endovascular Surgery, Clinical Center of Serbia from 1st of December 2011 to the 1st of November 2012. Results The prevalence of asymptomatic ICA stenosis ≥70% in patients with AAA is 10.8%. Male representatives have more symptomatic ICA stenosis ≥70%. Patients with small aneurysms more often have asymptomatic ICA stenosis ≥70%. The occurrence of symptoms of carotid disease was more prevalent among patients with ICA stenosis ≥70% compared to the group with stenosis <70%. There was no correlation found between the grade of ICA stenosis with the size of AAA. Conclusion The prevalence of asymptomatic ICA stenosis ≥70% in patients with AAA is found to be 10.8%. Male patients with ICA stenosis ≥70% more often had symptoms of carotid disease. In the smaller aneurysms, ICA stenosis ≥70% occurs frequently, but without the symptoms of carotid disease, and there was no correlation between the size of AAA and the grade of ICA stenosis. Clinical implications of ICA imaging in patients with previously diagnosed AAA is necessary.
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Affiliation(s)
- Milica Vranes
- Clinic for Vascular and Endovascular Surgery, Clinical Centre of Serbia, Belgrade, Serbia
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Ross N, Scott N, Duncan J. Uptake of Abdominal Aortic Aneurysm Screening. A Cohort Study. Eur J Vasc Endovasc Surg 2013; 45:610-5. [DOI: 10.1016/j.ejvs.2013.02.018] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2012] [Accepted: 02/21/2013] [Indexed: 11/29/2022]
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Wilson ECF, Emery JD, Kinmonth AL, Prevost AT, Morris HC, Humphrys E, Hall PN, Burrows N, Bradshaw L, Walls J, Norris P, Johnson M, Walter FM. The cost-effectiveness of a novel SIAscopic diagnostic aid for the management of pigmented skin lesions in primary care: a decision-analytic model. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2013; 16:356-366. [PMID: 23538188 DOI: 10.1016/j.jval.2012.12.008] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/15/2012] [Revised: 11/26/2012] [Accepted: 12/09/2012] [Indexed: 06/02/2023]
Abstract
OBJECTIVES Pigmented skin lesions are commonly presented in primary care. Appropriate diagnosis and management is challenging because the vast majority are benign. The MoleMate system is a handheld SIAscopy scanner integrated with a primary care diagnostic algorithm aimed at improving the management of pigmented skin lesions in primary care. METHODS This decision-model-based economic evaluation draws on the results of a randomized controlled trial of the MoleMate system versus best practice (ISRCTN79932379) to estimate the expected long-term cost and health gain of diagnosis with the MoleMate system versus best practice in an English primary care setting. The model combines trial results with data from the wider literature to inform long-term prognosis, health state utilities, and cost. RESULTS Results are reported as mean and incremental cost and quality-adjusted life-years (QALYs) gained, incremental cost-effectiveness ratio with probabilistic sensitivity analysis, and value of information analysis. Over a lifetime horizon, the MoleMate system is expected to cost an extra £18 over best practice alone, and yield an extra 0.01 QALYs per patient examined. The incremental cost-effectiveness ratio is £1,896 per QALY gained, with a 66.1% probability of being below £30,000 per QALY gained. The expected value of perfect information is £43.1 million. CONCLUSIONS Given typical thresholds in the United Kingdom (£20,000-£30,000 per QALY), the MoleMate system may be cost-effective compared with best practice diagnosis alone in a primary care setting. However, there is considerable decision uncertainty, driven particularly by the sensitivity and specificity of MoleMate versus best practice, and the risk of disease progression in undiagnosed melanoma; future research should focus on reducing uncertainty in these parameters.
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Mackie SL, Hensor EMA, Morgan AW, Pease CT. Should I send my patient with previous giant cell arteritis for imaging of the thoracic aorta? A systematic literature review and meta-analysis. Ann Rheum Dis 2012; 73:143-8. [PMID: 23264356 DOI: 10.1136/annrheumdis-2012-202145] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To review the literature in order to estimate how many previously unknown thoracic aortic aneurysms (TAAs) and thoracic aortic dilatations (TADs) might be detected by systematic, cross-sectional aortic imaging of patients with giant cell arteritis (GCA). METHODS A systematic literature review was performed using Ovid Medline, Embase and the Cochrane Library. Studies potentially relevant to TAA/TAD were evaluated by two authors independently for relevance, bias and heterogeneity. Meta-analysis was performed using a random-effects model to estimate pooled prevalence. RESULTS Two analyses of routinely collected administrative data suggested a threefold risk of TAA/dissection in GCA compared with controls. In GCA cohorts without systematic imaging, 2-8% had TAA. In the two best-reported studies, aneurysm dissection/rupture occurred in 1% and 6% of GCA cases. Aortic imaging studies had a variety of TAA/TAD definitions, imaging methods and time points. There were limited data on age-matched controls. Three studies suggested that male sex may be a risk factor for TAA/TAD in GCA. On average, five to ten patients with GCA would need aortic imaging to detect one previously unknown TAA/TAD. CONCLUSIONS The data support an association between GCA and TAA/TAD compared with age-matched controls, but the true relative risk, and the time course of that risk, remains unclear. It is also unclear whether chest radiography is a sufficiently sensitive screening tool. Clinicians should retain a high index of suspicion for aortic pathology in patients with GCA. Before ordering imaging, clinicians should consider whether, and how, detecting aortic pathology would affect a patient's management.
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Affiliation(s)
- Sarah Louise Mackie
- NIHR-Leeds Musculoskeletal Biomedical Research Unit, Leeds Institute of Molecular Medicine, , Leeds, West Yorkshire, UK
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Thompson SG, Ashton HA, Gao L, Buxton MJ, Scott RAP. Final follow-up of the Multicentre Aneurysm Screening Study (MASS) randomized trial of abdominal aortic aneurysm screening. Br J Surg 2012; 99:1649-56. [PMID: 23034729 PMCID: PMC3569614 DOI: 10.1002/bjs.8897] [Citation(s) in RCA: 187] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/25/2012] [Indexed: 11/08/2022]
Abstract
BACKGROUND The long-term effects of abdominal aortic aneurysm (AAA) screening were investigated in extended follow-up from the UK Multicentre Aneurysm Screening Study (MASS) randomized trial. METHODS A population-based sample of men aged 65-74 years were randomized individually to invitation to ultrasound screening (invited group) or to a control group not offered screening. Patients with an AAA (3·0 cm or larger) detected at screening underwent surveillance and were offered surgery after predefined criteria had been met. Cause-specific mortality data were analysed using Cox regression. RESULTS Some 67 770 men were enrolled in the study. Over 13 years, there were 224 AAA-related deaths in the invited group and 381 in the control group, a 42 (95 per cent confidence interval 31 to 51) per cent reduction. There was no evidence of effect on other causes of death, but there was an overall reduction in all-cause mortality of 3 (1 to 5) per cent. The degree of benefit seen in earlier years of follow-up was slightly diminished by the occurrence of AAA ruptures in those with an aorta originally screened normal. About half of these ruptures had a baseline aortic diameter in the range 2·5-2·9 cm. It was estimated that 216 men need to be invited to screening to save one death over the next 13 years. CONCLUSION Screening resulted in a reduction in all-cause mortality, and the benefit in AAA-related mortality continued to accumulate throughout follow-up. REGISTRATION NUMBER ISRCTN37381646 (http://www.controlled-trials.com).
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Affiliation(s)
- S G Thompson
- Department of Public Health and Primary Care, University of Cambridge, UK.
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46
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Darwood R, Brooks M. The Impact of Decreasing Abdominal Aortic Aneurysm Prevalence on a Local Aneurysm Screening Programme. Eur J Vasc Endovasc Surg 2012; 44:45-50. [DOI: 10.1016/j.ejvs.2012.04.010] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2011] [Accepted: 04/10/2012] [Indexed: 11/30/2022]
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Duncan JL, Harrild KA, Iversen L, Lee AJ, Godden DJ. Long term outcomes in men screened for abdominal aortic aneurysm: prospective cohort study. BMJ 2012; 344:e2958. [PMID: 22563092 PMCID: PMC3344734 DOI: 10.1136/bmj.e2958] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To determine whether there is a relation between aortic diameter and morbidity and mortality in men screened for abdominal aortic aneurysm. DESIGN Prospective cohort study. SETTING Highland and Western Isles (a large, sparsely populated area of Scotland). PARTICIPANTS 8146 men aged 65-74. MAIN OUTCOME MEASURES Morbidity and mortality in relation to presence of abdominal aortic aneurysm and three categories of aortic diameter (≤ 24 mm, 25-29 mm, and ≥ 30 mm). RESULTS When screened, 414 men (5.1%) had an aneurysm (diameter ≥ 30 mm), 669 (8.2%) an aortic diameter of 25-29 mm, and 7063 (86.7%) an aortic diameter of ≤ 24 mm. The cohort was followed up for a median of 7.4 (interquartile range 6.9-8.2) years. Mortality was significantly associated with aortic diameter: 512 (7.2%) men in the ≤ 24 mm group died compared with 69 (10.3%) in the 25-29 mm group and 73 (17.6%) in the ≥ 30 mm group. The mortality risk in men with an aneurysm or with an aorta measuring 25-29 mm was significantly higher than in men with an aorta of ≤ 24 mm. The increased mortality risk in the 25-29 mm group was reduced when taking confounders such as smoking and known heart disease into account. After adjustment, compared with men with an aortic diameter of ≤ 24 mm, the risk of hospital admission for cardiovascular disease and chronic obstructive pulmonary disease was significantly higher in men with aneurysm and those with aortas measuring 25-29 mm. Men with an aneurysm also had an increased risk of hospital admission for cerebrovascular disease, atherosclerosis, peripheral arterial disease, and respiratory disease. In men with aortas measuring 25-29 mm, the risk of hospital admission with abdominal aortic aneurysm was significantly higher than in men with an aorta of ≤ 24 mm (adjusted hazard ratio 6.7, 99% confidence interval 3.4 to 13.2) and this increased risk became apparent two years after screening. CONCLUSIONS Men with abdominal aortic aneurysm and those with aortic diameters measuring 25-29 mm have an increased risk of mortality and subsequent hospital admissions compared with men with an aorta diameter of ≤ 24 mm. Consideration should be given to control of risk factors and to rescreening men with aortas measuring 25-29 mm at index scanning.
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Affiliation(s)
- John L Duncan
- Department of Surgery, Raigmore Hospital, Inverness IV2 3UJ, UK.
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Navas EV, McCalla-Lewis A, Fernandez BB, Pinski SL, Novaro GM, Asher CR. Abdominal aortic aneurysm screening during transthoracic echocardiography: Cardiologist and vascular medicine specialist interpretation. World J Cardiol 2012; 4:31-5. [PMID: 22379535 PMCID: PMC3289891 DOI: 10.4330/wjc.v4.i2.31] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2011] [Revised: 12/10/2011] [Accepted: 12/17/2011] [Indexed: 02/06/2023] Open
Abstract
AIM To study the interobserver variability between a cardiologist and vascular medicine specialist in the screening of the abdominal aorta during transthoracic echocardiography (TTE). METHODS Consecutive patients, > 55 years of age, underwent abdominal aortic imaging following standard TTE. Two cardiologists and one vascular medicine specialist performed a blinded review of the images. Interobserver agreement of abdominal aortic size was determined by the correlation coefficient and paired t test. Interobserver reliability for each cardiologist was assessed using Bland-Altman plots. RESULTS Ninety patients were studied. The mean age of patients was 72 ± 10 years and 48% were male. The mean aortic diameter was 2.31 ± 0.50 cm and 5 patients (5.5%) had an abdominal aortic aneurysm (AAA). The additional time required for the abdominal aortic images was 4.4 ± 0.9 min per patient. Interobserver agreement between the 2 cardiologist interpreters and the vascular medicine specialist was excellent (P > 0.05 for all comparisons). On Bland-Altman analysis of interobserver reliability, the 95% lower and upper limits for measurement by the cardiologists were 84% and 124% of that of the vascular specialist. CONCLUSION The assessment of the abdominal aorta during a routine TTE performed by a cardiologist is accurate in comparison to that of a vascular medicine specialist. In selected patients undergoing TTE, the detection rate of AAA is significant. Additional time and effort required to perform imaging of the abdominal aorta after TTE is less than 5 min.
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Affiliation(s)
- E Viviana Navas
- E Viviana Navas, Andrea McCalla-Lewis, Sergio L Pinski, Gian M Novaro, Craig R Asher, Department of Cardiology, Cleveland Clinic Florida, Weston, FL 33327, United States
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Abbas A, Smith A, Cecelja M, Waltham M. Assessment of the Accuracy of AortaScan for Detection of Abdominal Aortic Aneurysm (AAA). Eur J Vasc Endovasc Surg 2012; 43:167-70. [DOI: 10.1016/j.ejvs.2011.11.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2011] [Accepted: 11/08/2011] [Indexed: 10/14/2022]
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Abstract
Ruptured AAA ranks as the 15th leading cause of death overall in the United States, and the 10th leading cause of death in men older than 55 years. Early identification of AAA can save livesand diminish cost. Screening programs havebeen implemented and studied in other countries and have shown a measurable and significant reduction in overall rate of aneurysm-related death. Currently, one-time screening of a small number of ever-smoking men when they turn 65 screening is not widely used in the United States and Medicare, at best, provides one-time screening of a small number of ever-smoking men when they turn 65 years old. Because more than 30,000 individuals in the United States die each year of ruptured AAA, a great deal of progress must be made to eradicate rupture from aneurysmal disease. A more comprehensive system of screening is required and this should be uniformly applied to the U.S. population. It is hoped that scoring systems such as the one outlined in this article, if widely adopted, can greatly enhance screening for aneurysmal disease and prevent the high mortality that stems from this serious vascular disease.
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Affiliation(s)
- Joseph L Bobadilla
- Department of Surgery, University of Wisconsin-Madison, Clinical Science Center H4/710, 600 Highland Avenue, Madison, WI 53792-7375, USA
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