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Sartori A, Tfaily A, Botteri E, Andreuccetti J, Lauro E, Caliskan G, Verlato G, Di Leo A. Rectus muscle diastasis in Italian women: determinants of disease severity, and associated disorders. Front Surg 2024; 11:1360207. [PMID: 38529469 PMCID: PMC10961386 DOI: 10.3389/fsurg.2024.1360207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Accepted: 02/19/2024] [Indexed: 03/27/2024] Open
Abstract
Purpose Diastasis of rectus abdominis (DRA) refers to a separation of the rectus abdominis from the linea alba, which is common in the female population during pregnancy and in the postpartum period. The present study aimed at investigating DRA severity, risk factors and associated disorders. Methods In the present cross-sectional study, a web-based questionnaire was addressed to the 23,000 members of the Women's Diastasis Association. The questionnaire comprised three parts, dedicated respectively to diastasis characteristics, possible risk factors, and related disorders. Faecal and urinary incontinences were assessed using the Wexner and ICIQ-SF score, respectively. Risk factors for diastasis severity (<3, 3-5, >5 cm) were evaluated by a multinomial regression model. Results Four thousand six hundred twenty-nine women with a mean age (SD) of 39.8 (6.5) years and a median BMI of 23.7 kg/m2 (range 16.0-40.0) responded to the questionnaire. Proportion of DRA >5 cm increased from 22.8% in norm weight women to 44.0% in severely obese women, and from 10.0% in nulliparous women to 39.3% in women with >3 pregnancies. These associations were confirmed in multivariable analysis. DRA severity was associated with the risk of abdominal hernia and pelvic prolapse, whose prevalence more than doubled from women with DRA <3 cm (31.6% and 9.7%, respectively) to women with DRA >5 cm (68.2% and 20.2%). In addition, most patients reported postural pain and urinary incontinence, whose frequency increased with DRA severity. Conclusion The present study confirmed that DRA severity increases with increasing BMI and number of pregnancies. Larger separation between rectal muscles was associated with increased risk of pain/discomfort, urinary incontinence, abdominal hernia and pelvic prolapse. Prospective studies are needed to better evaluate risk factors.
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Affiliation(s)
- Alberto Sartori
- U.O. Chirurgia Generale e d'Urgenza, Ospedale Montebelluna, Montebelluna, Italy
| | - Ahmad Tfaily
- Unit of Epidemiology and Medical Statistics, Department of Diagnostics & Public Health, University of Verona, Verona, Italy
| | - Emanuele Botteri
- General Surgery, ASST Spedali Civili di Brescia, Montichiari, Italy
| | | | - Enrico Lauro
- U.O. Chirurgia Generale, Ospedale Civile Santa Maria del Carmine, Rovereto, Italy
| | - Gulser Caliskan
- Unit of Epidemiology and Medical Statistics, Department of Diagnostics & Public Health, University of Verona, Verona, Italy
| | - Giuseppe Verlato
- Unit of Epidemiology and Medical Statistics, Department of Diagnostics & Public Health, University of Verona, Verona, Italy
| | - Alberto Di Leo
- U.O. Chirurgia Generale e Mininvasiva, Ospedale San Camillo, Trento, Italy
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Ugurlu C, Gok H, Sahin A, Bayar B, Olcucuoglu E, Kulacoglu H. Prevalence of rectus diastasis is higher in patients with inguinal hernia. Hernia 2023:10.1007/s10029-023-02820-0. [PMID: 37335520 DOI: 10.1007/s10029-023-02820-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Accepted: 06/04/2023] [Indexed: 06/21/2023]
Abstract
PURPOSE To determine the prevalence of rectus diastasis (RD) in patients with inguinal hernia. MATERIAL AND METHODS Multicenter, cross-sectional study. Patients with inguinal hernia were included in the study group (IH) and those with benign proctologic complaints created the control group (CG). Age, gender, BMI, family history for inguinal hernias, comorbid diseases, alcohol use, smoking, constipation, malignancy, chemotherapy, number of births, multiple pregnancies and prostate hypertrophy history of all patients in both groups were recorded. All patients were evaluated for RD and umbilical hernias by physical examination. RESULTS A total of 528 consecutive patients were included in the study (292 IH / 236 CG). Overall prevalence of RD was 35.6% and it was significantly higher in IH than in CG (46.9% vs 21.6%, p < 0.001). Also, umbilical hernia was more frequently detected in the patients with inguinal hernia. Other risk factors for RD were age, BMI, DM, BPH and smoking. The mean inter-rectus distance for 528 patients was 18.1 mm; it was 20.71 ± 10.68 mm in IH and 14.88 ± 8.82 in CG (p < 0.001). It was determined that the increase in age and BMI caused an increase in the inter-rectus distance, and that the presence of DM, inguinal hernia and umbilical hernia increased the inter-rectus distance quantitatively. CONCLUSIONS The prevalence of RD seems to be higher in patients with inguinal hernia comparing to that in general population. Increased age, high BMI and DM were found to be independent risk factors for RD development.
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Affiliation(s)
- C Ugurlu
- Department of General Surgery, Faculty of Medicine, Gaziosmanpasa University, Sevki Erek Yerleskesi, 60030, Tokat, Turkey.
| | - H Gok
- Department of General Surgery, Hernia Istanbul Comprehensive Hernia Center, Istanbul, Turkey
| | - A Sahin
- Department of General Surgery, University of Health Science, Konya City Hospital, Konya, Turkey
| | - B Bayar
- Department of General Surgery, Mus State Hospital, Mus, Turkey
| | - E Olcucuoglu
- Department of General Surgery, Diskapi Yildirim Beyazit Teaching and Research Hospital, Ankara, Turkey
| | - H Kulacoglu
- Department of General Surgery, Ankara Hernia Center, Ankara, Turkey
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Benjamin DR, Frawley HC, Shields N, Peiris CL, van de Water ATM, Bruder AM, Taylor NF. Conservative interventions may have little effect on reducing diastasis of the rectus abdominis in postnatal women - A systematic review and meta-analysis. Physiotherapy 2023; 119:54-71. [PMID: 36934466 DOI: 10.1016/j.physio.2023.02.002] [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: 12/03/2021] [Revised: 11/23/2022] [Accepted: 02/23/2023] [Indexed: 03/07/2023]
Abstract
BACKGROUND Diastasis of the rectus abdominis muscle (DRAM) commonly occurs in pregnancy and postnatally. Physiotherapists routinely guide women in its management, although the effectiveness of these treatments is unknown. OBJECTIVES To determine the effectiveness of conservative interventions to reduce the presence and width of DRAM in pregnant and postnatal women. DATA SOURCES EMBASE, Medline, CINAHL, PUBMED, AMED and PEDro searched until August 2021. STUDY SELECTION/ELIGIBILITY Randomised control trials examining any conservative interventions to manage DRAM during the ante- and postnatal periods were included. STUDY APPRAISAL AND SYNTHESIS METHODS Methodological quality was assessed using the Cochrane Risk of Bias 2 tool. Meta-analyses were performed using a random effects model to calculate mean differences (MD) and odds ratios (OR). A GRADE approach determined the certainty of evidence for each meta-analysis. RESULTS Sixteen trials with 698 women during the postnatal period were included. No trials evaluated interventions during the antenatal period. All interventions included some form of abdominal exercise. Other interventions included abdominal binding, kinesiotape and electrical stimulation. There was moderate certainty evidence from six trials (n = 161) that abdominal exercise led to a small reduction in inter-recti distance (MD -0.43 cm, 95% CI -0.82 to -0.05) in postnatal women compared to usual care. LIMITATIONS Three of the 16 trials had a low risk of bias. CONCLUSION AND IMPLICATIONS Conservative interventions do not lead to clinically significant reductions in inter-recti distance in women postnatally but abdominal exercises may have other physical and psychosocial benefits in the management of DRAM. Systematic Review Registration Number PROSPERO (CRD42020172529).
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Affiliation(s)
- Deenika R Benjamin
- Physiotherapy, School of Allied Health, Human Services and Sport, La Trobe University, Kingsbury Drive, Bundoora 3086, Australia.
| | - Helena C Frawley
- Melbourne School of Health Sciences, The University of Melbourne, Victoria, Australia; Allied Health Research, Royal Women's Hospital, Australia; Allied Health Research, Mercy Hospital for Women, Australia.
| | - Nora Shields
- Olga Tennison Autism Research Centre, School of Psychology and Public Health, La Trobe University, Victoria 3086, Australia.
| | - Casey L Peiris
- Physiotherapy, School of Allied Health, Human Services and Sport, La Trobe University, Kingsbury Drive, Bundoora 3086, Australia.
| | - Alexander T M van de Water
- Physiotherapy, School of Allied Health, Human Services and Sport, La Trobe University, Kingsbury Drive, Bundoora 3086, Australia.
| | - Andrea M Bruder
- Physiotherapy, School of Allied Health, Human Services and Sport, La Trobe University, Kingsbury Drive, Bundoora 3086, Australia.
| | - Nicholas F Taylor
- Physiotherapy, School of Allied Health, Human Services and Sport, La Trobe University, Kingsbury Drive, Bundoora 3086, Australia; Allied Health Clinical Research Office, Eastern Health 5 Arnold Street, Box Hill 3128, Australia.
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Yuan S, Li Y, Li Q, Fan L, Zhou J. Surgery Versus Non-surgery Interventions on Rectus Abdominis Diastasis With or Without Hernias: a Systematic Review. Indian J Surg 2022. [DOI: 10.1007/s12262-021-02792-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Cavalli M, Aiolfi A, Bruni PG, Manfredini L, Lombardo F, Bonfanti MT, Bona D, Campanelli G. Prevalence and risk factors for diastasis recti abdominis: a review and proposal of a new anatomical variation. Hernia 2021; 25:883-890. [PMID: 34363190 PMCID: PMC8370915 DOI: 10.1007/s10029-021-02468-8] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 07/16/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE Diastasis recti abdominis (DRA) or rectus diastasis is an acquired condition in which the rectus muscles are separated by an abnormal distance along their length, but with no fascia defect. To data there is no consensus about risk factors for DRA. The aim of this article is to critically review the literature about prevalence and risk factor of DRA. METHOD A total of 13 papers were identified. RESULTS The real prevalence of DRA is unknown because the prevalence rate varies with measurement method, measurement site and judgment criteria, but it is certainly an extremely frequent condition. Numbers of parity, BMI, diabetes are the most plausible risk factors. We identified a new anatomical variation in cadaveric dissection and in abdominal CT image evaluation: along the semilunar line the internal oblique aponeurosis could join the rectus sheath with only a posterior layer, so without a double layer (anterior and posterior) as usually described. We conducted a retrospective review of abdominal CT images and the presence of the posterior insertion only could be considered as a risk factor for DRA. CONCLUSION Further studies with large sample size, including nulliparous, primiparous, pluriparous and men too, are necessary for identify the real prevalence.
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Affiliation(s)
- M Cavalli
- Center of Research on the Pathology and High Specialization on the Abdominal Wall and Hernia Surgery, University of Insubria, Milano Hernia Center, Istituto Clinico Sant'Ambrogio, Via Faravelli 16, 20147, Milano, Italy.
| | - A Aiolfi
- Department of Biomedical Science for Health, Division of General Surgery, University of Milan, Istituto Clinico Sant'Ambrogio, Via Luigi Faravelli 16, 20147, Milan, Italy
| | - P G Bruni
- Center of Research on the Pathology and High Specialization on the Abdominal Wall and Hernia Surgery, University of Insubria, Milano Hernia Center, Istituto Clinico Sant'Ambrogio, Via Faravelli 16, 20147, Milano, Italy
| | - L Manfredini
- Center of Research on the Pathology and High Specialization on the Abdominal Wall and Hernia Surgery, University of Insubria, Milano Hernia Center, Istituto Clinico Sant'Ambrogio, Via Faravelli 16, 20147, Milano, Italy
| | - F Lombardo
- Department of Biomedical Science for Health, Division of General Surgery, University of Milan, Istituto Clinico Sant'Ambrogio, Via Luigi Faravelli 16, 20147, Milan, Italy
| | - M T Bonfanti
- Casa Di Cura La Madonnina, via Quadronno 29, 20122, Milan, Italy
| | - D Bona
- Department of Biomedical Science for Health, Division of General Surgery, University of Milan, Istituto Clinico Sant'Ambrogio, Via Luigi Faravelli 16, 20147, Milan, Italy
| | - G Campanelli
- Center of Research on the Pathology and High Specialization on the Abdominal Wall and Hernia Surgery, University of Insubria, Milano Hernia Center, Istituto Clinico Sant'Ambrogio, Via Faravelli 16, 20147, Milano, Italy
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Nienhuijs SW, Berkvens EHM, de Vries Reilingh TS, Mommers EHH, Bouvy ND, Wegdam J. The male rectus diastasis: a different concept? Hernia 2021; 25:951-956. [PMID: 34297251 DOI: 10.1007/s10029-021-02467-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Accepted: 07/16/2021] [Indexed: 11/24/2022]
Abstract
PURPOSE More interest in the treatment of rectus diastasis has been evoked lately. Following the postpartum females from a great distance, the middle-aged males living with obesity are the second most common group of rectus diastasis patients. Although gender differences are considered frequently in regard to cosmetic appearance and symptoms, it is less obvious in classifications and subsequent treatment strategies. Is a unisex approach of rectus diastasis still applicable? The lack of a firm answer warrants this review of the current literature. METHODS An explorative free-text multi-database bibliographic search (Pubmed/CENTRAL/EMBASE/PEDro/Scholar) was performed with the focus on the rectus diastasis in males. Anticipating the limited references, the design was a non-systematic review. All studies, regardless of study type, language or time period, describing etiology, symptoms, classification and/or treatment options were eligible for inclusion. From the articles retrieved out of this search, additional references were identified by a manual search among the cited references. RESULTS The multi-database search resulted in a total of 7633 records. Based on the title and abstract 95 records were full text assessed for eligibility. Eleven studies were identified as relevant, six by cross-reference and another four by hand-search were added to provide an insight in gender-specific aspects in rectus diastase. Hereditary causes are differences in collagen-like composition of types and concomitant abdominal aneurysm as well as gender differences in the linea alba architecture. Acquired etiology is distributed into both absolute pressure by visceral obesity and relative pressure caused by weight lifting or improper exercises. Furthermore, the impact of muscle thickness and age are considered as influencers of biomechanics. Gender differences can also play a role in symptoms of body image and core stability. It is known that there are anatomical differences between male and female persons; more transverse fibers are found in infra-umbilical region in women. In classifications the awareness of male rectus diastasis is limited, treatment outcome studies are scarce on males. CONCLUSION An overview of male-specific aspects of rectus diastasis is provided, underlining that key aspects surrounding rectus diastasis in males differ from females. Although males are the minority of rectus diastasis patients, we recommend that the male rectus diastasis as a concept should be specifically acknowledged in classifications systems and study outcome reporting to evaluate this subgroup more accurately in the future.
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Affiliation(s)
- S W Nienhuijs
- Department of Surgery, Catharina Hospital Eindhoven, Michelangelolaan 2, Eindhoven, 5623 EJ, The Netherlands.
| | - E H M Berkvens
- Department of Physiotherapy, Elkerliek Hospital Helmond, Helmond, The Netherlands
| | | | - E H H Mommers
- Department of Radiology, Maastricht University Hospital, Maastricht, The Netherlands
| | - N D Bouvy
- Department of Surgery, Maastricht University Hospital, Maastricht, The Netherlands
| | - J Wegdam
- Department of Surgery, Elkerliek Hospital Helmond, Helmond, The Netherlands
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Benjamin DR, Frawley HC, Shields N, Georgiou C, Taylor NF. Establishing measurement properties in the assessment of inter-recti distance of the abdominal muscles in a postnatal women. Musculoskelet Sci Pract 2020; 49:102202. [PMID: 32861363 DOI: 10.1016/j.msksp.2020.102202] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2020] [Revised: 05/28/2020] [Accepted: 06/02/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Diastasis of the rectus abdominis muscle is often evaluated in clinical practice but it is unknown which clinical method has the best measurement properties. OBJECTIVE The aim of this study was to determine: (i) the criterion validity of the callipers, tape measure and finger-width to evaluate the inter-recti distance of the abdominal muscles compared to ultrasound; and (ii) inter-rater and retest reliability of these methods. DESIGN Measurement study. METHODS Two physiotherapists assessed the inter-recti distance of rectus abdominis on 50 women postnatally using the three clinical methods. These measurements were compared to ultrasound and assessed for inter-rater and retest reliability. RESULTS Callipers had very good positive correlations with ultrasound (r = 0.85 to 0.99) and narrow limits of agreement (LOA) (<6 mm). Finger-width and tape measure had moderate to very good correlation with ultrasound (tape measure r = 0.82 to 0.98; finger-width r = 0.75 to 0.98) with wider limits of agreement (tape measure LOA <8 mm; finger-width LOA <18 mm). Callipers demonstrated excellent inter-rater (ICC = 0.80 to 0.99) and retest (ICC = 1.00) reliability. Inter-rater reliability testing was very good for tape measure (ICC = 0.80 to 0.97) and moderate to very good (ICC = 0.44 to 0.85) for finger-width. Retest reliability demonstrated very good reliability (ICC = 0.99 to 1.00) for both finger-width and tape measure. The largest inter-recti distances, strongest correlations and reliability were found at the level of the lower umbilicus. CONCLUSION Callipers, tape measure and finger-width are valid and reliable methods of measuring inter-recti distance in postnatal women. Validity, and relative and absolute reliability were found to be the strongest using the callipers.
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Affiliation(s)
- Deenika R Benjamin
- School of Allied Health, Human Services and Sport, La Trobe University, Victoria, Australia.
| | - Helena C Frawley
- School of Primary and Allied Health Care, Faculty of Medicine, Nursing and Health Sciences, Monash University, Victoria, Australia
| | - Nora Shields
- School of Allied Health, Human Services and Sport, La Trobe University, Victoria, Australia
| | - Chris Georgiou
- Obstertrics & Gynecology, Eastern Health, Victoria, Australia
| | - Nicholas F Taylor
- School of Allied Health, Human Services and Sport, La Trobe University, Victoria, Australia; Allied Health Clinical Research Office, Eastern Health, Victoria, Australia
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Benjamin DR, Frawley HC, Shields N, van de Water AT, Taylor NF. Relationship between diastasis of the rectus abdominis muscle (DRAM) and musculoskeletal dysfunctions, pain and quality of life: a systematic review. Physiotherapy 2019; 105:24-34. [DOI: 10.1016/j.physio.2018.07.002] [Citation(s) in RCA: 53] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Accepted: 07/19/2018] [Indexed: 11/29/2022]
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Lun Y, Jiang H, Jing Y, Xin S, Zhang J. Saphenous vein graft aneurysm formation in a patient with idiopathic multiple aneurysms. J Vasc Surg Cases Innov Tech 2018; 4:197-200. [PMID: 30148238 PMCID: PMC6105753 DOI: 10.1016/j.jvscit.2018.04.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2018] [Accepted: 04/06/2018] [Indexed: 01/17/2023] Open
Abstract
True aneurysmal vein graft dilation is rare, and its etiology remains speculative. However, systemic dilation diathesis is regarded as a risk factor. We herein report a case of a rapidly expanding aneurysm in a great saphenous vein graft, resulting in distal malperfusion in a patient who had previously undergone open repair of multiple popliteal artery aneurysms. After an unsuccessful endovascular intervention, the dilated section was eventually replaced by a reversed segment of the contralateral great saphenous vein. Subsequent whole-exome sequencing identified no relevant mutations. This case provides further evidence that aneurysmal disease may be associated with systemic dilation diathesis.
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Affiliation(s)
| | | | | | | | - Jian Zhang
- Department of Vascular Surgery, The First Hospital, China Medical University, Shenyang, China
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Soybel DI. Abdominal rectus diastasis: Questions of wellness and biology. Surgery 2016; 160:1376-1378. [PMID: 27495849 DOI: 10.1016/j.surg.2016.06.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2016] [Accepted: 06/17/2016] [Indexed: 11/18/2022]
Affiliation(s)
- David I Soybel
- Pennsylvania State University, College of Medicine, Hershey, PA.
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Abstract
STUDY DESIGN Clinical measurement, concurrent validity criterion standard. OBJECTIVE To determine the concurrent validity of digital nylon calipers in comparison to ultrasound imaging (USI) for the measurement of interrecti distance (IRD). BACKGROUND Diastasis rectus abdominis is the abnormal increase in the width of the linea alba, measured as IRD. A diastasis rectus abdominis can compromise mechanical trunk function in both genders. IRD has been accurately measured with USI but requires costly equipment and extensive examiner training. Digital nylon calipers are inexpensive and easy to use, but their use to measure IRD has not been validated. METHODS A sample of convenience of 56 individuals (11 men, 45 women) was measured. A single examiner was assigned to each tool (calipers or USI), and IRD was measured at 2 locations (above and below the umbilicus) under 2 conditions (abdominal muscles at rest and abdominal muscles contracted). All measurements were made during a single session, and examiners were blinded to measurements with the other tool. RESULTS Above the umbilicus, the measurements of IRD with calipers were similar to those made with USI, with intraclass correlation coefficients (model 3,2) of 0.79 with abdominal muscles at rest and 0.71 with abdominal muscles contracted. The absolute mean difference between the caliper and USI measurements of IRD above the umbilicus was 0.03 cm larger with the calipers when the abdominal muscles were at rest and 0.03 cm smaller when the abdominal muscles were contracted. The values of IRD obtained with the caliper and USI techniques were not comparable when obtained below the umbilicus. CONCLUSION The calipers are a valid tool for measuring IRD above the umbilicus in males and females. Measuring IRD with calipers below the umbilicus should not be considered valid, using USI as the criterion standard. This may reflect anatomical variation of the linea alba or a limitation of the calipers to assess IRD at the same depth as USI.
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Pannu R, McPhail IR. Prevalence of Abdominal Wall Hernia in Participants With Abdominal Aortic Aneurysm Versus Peripheral Arterial Disease—A Population-Based Study. Angiology 2011; 63:146-9. [DOI: 10.1177/0003319711409922] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Small studies suggest an association between abdominal aortic aneurysms (AAAs) and hernias, possibly related to connective tissue weakness. We evaluated the association between AAA and abdominal wall hernia (AWH), using peripheral arterial disease (PAD) patients as controls, in Olmsted County, Minnesota. In a retrospective cohort study we queried the electronic medical records for the diagnosis of AAA. The resulting data were then queried for prevalence of AWH. The same set of queries was repeated for PAD. Occurrence of AWH in the 2 groups was compared using the chi-square test. Of the 187 151 patient records queried, 939 had AAA and 3465 had PAD. Abdominal wall hernia occurred in 157 (16.7%) patients with AAA and in 343 (9.9%) patients with PAD. Abdominal wall hernia was 1.7 times more prevalent in those with AAA versus PAD ( P < .0001). A history of hernia may prompt screening for AAA in some patients.
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Affiliation(s)
- Rajmony Pannu
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA
| | - Ian R. McPhail
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA
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Abstract
Abdominal aortic aneurysms (AAAs) are found in up to 8% of men aged >65 years, yet usually remain asymptomatic until they rupture. Rupture of an AAA and its associated catastrophic physiological insult carries overall mortality in excess of 80%, and 2% of all deaths are AAA-related. Pathologically, AAAs are associated with inflammation, smooth muscle cell apoptosis, and matrix degradation. Once thought to be a consequence of advanced atherosclerosis, accruing evidence indicates that AAAs are a focal representation of a systemic disease of the vasculature. Risk factors for AAAs include increasing age, male sex, smoking, and low HDL-cholesterol levels. Familial associations exist and although susceptibility genes have been described on the basis of candidate-gene studies, robust genetic studies have failed to discover causative gene mutations. The surgical management of AAAs has been revolutionized by minimally invasive endovascular repair. Ongoing randomized trials will establish whether endovascular repair confers a survival advantage over open surgery for patients with a ruptured AAA. In many countries, centralization of vascular surgical services has largely been driven by the improved outcomes of elective aneurysm surgery in specialized centers, the widespread adoption of endovascular techniques, and the introduction of screening programs.
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De'Ath HDI, Lovegrove RE, Javid M, Peter N, Magee TR, Galland RB. An assessment of between-recti distance and divarication in patients with and without abdominal aortic aneurysm. Ann R Coll Surg Engl 2010; 92:591-4. [PMID: 20819246 DOI: 10.1308/003588410x12771863937089] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION The study assessed whether there is a greater incidence of divarication of the recti and whether between-recti distance is greater in patients with abdominal aortic aneurysm (AAA). PATIENTS AND METHODS The study consisted of two parts: a radiological and a clinical assessment. All patients with a confirmed AAA on computerised tomography were included and compared with patients in whom AAA was excluded with imaging. Between-recti distance was measured using a computerised image viewer and clinical divarication was assessed by a surgical registrar or consultant. RESULTS In the radiological part of the study, 108 patients with AAA were compared with 84 with colorectal cancer. Median between-recti distance was 38 mm (range, 25-59 mm) in the AAA group and 27 mm (range, 20-44.5 mm) in the non-AAA group (P=0.006). AAA diameter did not correlate with between-recti distance. The clinical study included 50 patients (25 AAA). The groups were well matched, with only a greater incidence of diabetes in the AAA group (20% vs 0%; P=0.018). AAA patients were more likely to have clinically detected divarication of the recti (76% vs 36%; P=0.004). CONCLUSIONS Patients with AAA have greater radiological and clinical evidence of divarication. It is suggested that patients with divarication be screened for AAA.
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Abstract
An association between abdominal aortic aneurysm (AAA) and abdominal wall hernia has been suggested, possibly reflecting a common collagen disorder. The same mechanism may also cause a greater frequency of diastasis recti among patients at risk of developing AAA. Diastasis recti could be used to identify patients at risk of AAA, with implications for AAA screening. The aim of this study was to determine whether an association between diastasis recti and AAA could be demonstrated. The preoperative computed tomographic (CT) scans of 75 male patients undergoing elective AAA repair were retrospectively examined and linea alba width recorded at supraumbilical and subumbilical levels. Measurements were compared with controls frequency matched for age. Fifty patients with AAA were observed to have supraumbilical diastasis recti on preoperative CT compared with 47 controls. Mean linea alba width was not significantly different between the two groups at either the supraumbilical (19.3 mm vs 20.7 mm, p = .45) or subumbilical (3.6 mm vs 4.3 mm, p = .43) level. The findings do not support the hypothesis that the presence of diastasis recti can serve as an indication to select male patients for screening for AAA.
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Affiliation(s)
- Todd Moesbergen
- *Department of Radiology, Christchurch Hospital; †University of Otago Christchurch School of Medicine; and ‡Department of Vascular, Endovascular and Transplant Surgery, Christchurch Hospital, Christchurch, New Zealand
| | - Alice Law
- *Department of Radiology, Christchurch Hospital; †University of Otago Christchurch School of Medicine; and ‡Department of Vascular, Endovascular and Transplant Surgery, Christchurch Hospital, Christchurch, New Zealand
| | - Justin Roake
- *Department of Radiology, Christchurch Hospital; †University of Otago Christchurch School of Medicine; and ‡Department of Vascular, Endovascular and Transplant Surgery, Christchurch Hospital, Christchurch, New Zealand
| | - David R. Lewis
- *Department of Radiology, Christchurch Hospital; †University of Otago Christchurch School of Medicine; and ‡Department of Vascular, Endovascular and Transplant Surgery, Christchurch Hospital, Christchurch, New Zealand
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Nordon IM, Hinchliffe RJ, Holt PJ, Loftus IM, Thompson MM. Review of Current Theories for Abdominal Aortic Aneurysm Pathogenesis. Vascular 2009; 17:253-63. [DOI: 10.2310/6670.2009.00046] [Citation(s) in RCA: 71] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Atherosclerotic plaques are a feature of abdominal aortic aneurysms (AAAs). Atherosclerosis and AAA appear to share similar risk factors. These observations have led to the conclusion that AAAs are a consequence of advanced atherosclerosis. This review explores current theories regarding the pathogenesis of AAA and their implications for treatment. A systematic literature search was conducted using the search terms abdominal aortic aneurysm, atherosclerosis, pathogenesis, and systemic disease. Articles were categorized according to the association of AAAs with atherosclerosis, arteriomegaly, peripheral aneurysm, systemic expression, genetics, autoimmunity, oxidative stress, and systemic disease. Twenty-nine articles reporting changes in the systemic vasculature associated with AAA and 12 articles examining the shared risk factor hypothesis were identified. There is insufficient evidence to confirm that AAAs are the result of advanced atherosclerosis. The bulk of evidence points to AAA disease being a systemic disease of the vasculature, with a predetermined genetic susceptibility leading to a phenotype governed by environmental factors.
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Affiliation(s)
- Ian M. Nordon
- *St George's Vascular Institute, St James' Wing, St George's Hospital, London, UK
| | - Robert J. Hinchliffe
- *St George's Vascular Institute, St James' Wing, St George's Hospital, London, UK
| | - Peter J. Holt
- *St George's Vascular Institute, St James' Wing, St George's Hospital, London, UK
| | - Ian M. Loftus
- *St George's Vascular Institute, St James' Wing, St George's Hospital, London, UK
| | - Matthew M. Thompson
- *St George's Vascular Institute, St James' Wing, St George's Hospital, London, UK
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