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Kim H, Kim J, Choe YH, Kim SM. The Prognostic Impact of Coronary Artery Disease and Aortic Aneurysm: Insights From CT Protocol for Simultaneous Evaluation of Coronary Artery and Aorta. J Korean Med Sci 2023; 38:e379. [PMID: 37987106 PMCID: PMC10659927 DOI: 10.3346/jkms.2023.38.e379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2023] [Accepted: 08/11/2023] [Indexed: 11/22/2023] Open
Abstract
BACKGROUND There is a strong correlation between risk factors for coronary artery disease (CAD) and aortic aneurysm (AA). We aimed to investigate the prevalence and prognostic impact of CAD and AA in patients who underwent coronary aorta computed tomography (CACT) protocol, which allowed simultaneous evaluation of coronary artery and aorta. METHODS Between 2010 and 2021, 1,553 patients who underwent CACT were enrolled from a tertiary center. The presence and location of AA and the presence of CAD were identified from CT. The primary outcome was a composite of cardiovascular death, acute coronary syndrome requiring urgent revascularization, and stroke at 3 years after the index CT scan. RESULTS Out of 1,553 enrolled patients, 179 (11.5%) had AA. The prevalence of CAD was significantly higher in patients with AA than those without (47.5% vs. 18.3%, P < 0.001). Among patients with AA, the prevalence of comorbid CAD was higher in those with abdominal AA than thoracic AA (57.3% vs. 37.8%, P = 0.014), respectively. In multivariable analysis, the presence of CAD was an independent predictor of primary outcome at 3 years (hazard ratio [HR], 2.58; 95% CI, 1.47-4.51; P = 0.001), while AA was not (HR, 1.00; 95% CI, 0.48-2.07; P = 0.993). CONCLUSION In this cohort of patients undergoing simultaneous evaluation of coronary artery and aorta using CACT protocol, patients with AA had an increased risk of comorbid CAD compared to those without AA. CAD was independently associated with adverse clinical outcomes at 3 years.
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Affiliation(s)
- Hoyoung Kim
- Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jihoon Kim
- Division of Cardiology, Department of Internal Medicine, Samsung Medical Center, Seoul, Korea
- Cardiovascular Imaging Center, Heart Vascular Stroke Institute, Samsung Medical Center, Seoul, Korea.
| | - Yeon Hyeon Choe
- Sungkyunkwan University School of Medicine, Seoul, Korea
- Cardiovascular Imaging Center, Heart Vascular Stroke Institute, Samsung Medical Center, Seoul, Korea
- Department of Radiology, Samsung Medical Center, Seoul, Korea
| | - Sung Mok Kim
- Sungkyunkwan University School of Medicine, Seoul, Korea
- Cardiovascular Imaging Center, Heart Vascular Stroke Institute, Samsung Medical Center, Seoul, Korea
- Department of Radiology, Samsung Medical Center, Seoul, Korea.
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Natale F, Molinari R, Covino S, Alfieri R, Limatola M, De Luca L, Pezzullo E, Izzo A, Cimmino G. A pitfall in the echographic diagnosis of abdominal aortic aneurysm: when para-aortic lymph nodes are the trick. Monaldi Arch Chest Dis 2023; 94. [PMID: 36843481 DOI: 10.4081/monaldi.2023.2516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Accepted: 02/14/2023] [Indexed: 02/28/2023] Open
Abstract
The abdominal aortic aneurysm (AAA) is a potentially fatal asymptomatic disease. It progresses silently with clinical complications that, when they occur, constitute a very serious event, frequently resulting in the patient's exitus. As a result, early detection and treatment are critical because the right therapeutic strategy can halt the disease's natural progression. AAA is frequently discovered as an incidental finding during an abdominal ultrasound or a plain X-ray of the abdomen, which is required for other pathologies. The primary diagnostic tool for AAA identification is abdominal B-mode ultrasound. It is cheap, widely available, non-invasive, and has high diagnostic sensitivity. However, this diagnostic tool may fail in rare cases due to misleading anatomical findings. We present an unusual flaw in the echographic AAA evaluation that should be considered during the diagnostic work-up.
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Affiliation(s)
| | | | - Simona Covino
- Vanvitelli Cardiology Unit, Monaldi Hospital, Naples.
| | | | | | | | | | - Andrea Izzo
- Section of Radiology, Department of Precision Medicine, University of Campania "L. Vanvitelli", Naples.
| | - Giovanni Cimmino
- Vanvitelli Cardiology Unit, Monaldi Hospital, Naples; Section of Cardiology, Department of Translational Medical Sciences, University of Campania "L. Vanvitelli", Naples.
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Kim H, Kim J, Choe YH, Kim SM. Clinical outcomes of a CT protocol for simultaneous examination of the aorta and coronary artery in patients with aortic aneurysm. Front Cardiovasc Med 2023; 10:1144444. [PMID: 37123481 PMCID: PMC10130567 DOI: 10.3389/fcvm.2023.1144444] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Accepted: 03/28/2023] [Indexed: 05/02/2023] Open
Abstract
Objectives In patients with aortic aneurysm (AA), coronary artery disease (CAD) increases the risk of perioperative complications and even asymptomatic CAD is associated with adverse clinical outcomes. We aimed to compare coronary-aorta CT (CACT) with thoracoabdominal CT angiography (Aorta CT) for CAD management and clinical outcomes in these patients. Methods We enrolled 479 patients undergoing CACT and 693 patients undergoing Aorta CT as an initial CT scan for AA. The primary outcome was a composite of all-cause death or myocardial infarction (MI) at 3 years after CT. The secondary outcomes were subsequent CAD management and invasive coronary angiography (CAG). Results After index CT scan, the CACT group had a significantly higher rate of coronary revascularization compared with the Aorta CT group (10.7% vs. 3.8%, p < 0.001) but a lower probability of diagnostic CAG among total invasive CAG (32% vs. 55%, p < 0.001). At 3 months after the CT scan, the prescription rates of statins (65.8% vs. 44.6%, p < 0.001) and antiplatelet agents (57.6% vs. 43.9%, p < 0.001) were higher in the CACT group. During follow-up, the CACT group had a significantly lower incidence of the composite outcome of all-cause death or MI (adjusted HR 1.72, 95% CI 1.07-2.78, p = 0.027) than the Aorta CT group. Conclusion Among patients with AA, CACT was associated with a higher rate of subsequent CAD management and a lower risk of all-cause death or MI compared to Aorta CT. When evaluating with AA using CT, simultaneous coronary and aortic evaluation using CACT would be recommended over Aorta CT.
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Affiliation(s)
- Hoyoung Kim
- Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jihoon Kim
- Division of Cardiology, Department of Internal Medicine, Samsung Medical Center, Seoul, Republic of Korea
- Cardiovascular Imaging Center, Heart Vascular Stroke Institute, Samsung Medical Center, Seoul, Republic of Korea
- Correspondence: Jihoon Kim Sung Mok Kim
| | - Yeon Hyeon Choe
- Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
- Cardiovascular Imaging Center, Heart Vascular Stroke Institute, Samsung Medical Center, Seoul, Republic of Korea
- Department of Radiology, Samsung Medical Center, Seoul, Republic of Korea
| | - Sung Mok Kim
- Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
- Cardiovascular Imaging Center, Heart Vascular Stroke Institute, Samsung Medical Center, Seoul, Republic of Korea
- Department of Radiology, Samsung Medical Center, Seoul, Republic of Korea
- Correspondence: Jihoon Kim Sung Mok Kim
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Kontopodis N, Galanakis N, Charalambous S, Matsagkas M, Giannoukas AD, Tsetis D, Ioannou CV, Antoniou GA. Editor's Choice - Endovascular Aneurysm Repair in High Risk Patients: A Systematic Review and Meta-Analysis. Eur J Vasc Endovasc Surg 2022; 64:461-474. [PMID: 35872342 DOI: 10.1016/j.ejvs.2022.07.009] [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: 02/11/2022] [Revised: 06/06/2022] [Accepted: 07/10/2022] [Indexed: 01/12/2023]
Abstract
OBJECTIVE To investigate outcomes of endovascular aneurysm repair (EVAR) in high risk patients. METHODS Bibliographic sources (MEDLINE, EMBASE, CINAHL, and CENTRAL) were searched using combinations of thesaurus and free text terms. The review protocol was registered in PROSPERO (CRD42021287207) and reported according to PRISMA 2020. Pooled estimates were calculated using odds ratio (OR) or hazard ratio (HR) and 95% confidence interval (CI) applying the Mantel-Haenszel or inverse variance method. EVAR peri-operative mortality in high risk patients over time was examined with mixed effects meta-regression. The GRADE framework was used to rate the certainty of evidence. RESULTS The pooled peri-operative mortality in 18 416 high risk patients who underwent EVAR was 3% (95% CI 2.3 - 4%) and has significantly reduced over time (year of publication p = .003; median study point p = .023). The peri-operative mortality was significantly lower in high risk patients treated with EVAR compared with open repair (OR 0.64; 95% CI 0.45 - 0.92), but no significant difference was found in overall (HR 1.06; 95% CI 0.76 - 1.49) or aneurysm related mortality (HR 0.57; 95% CI 0.21 - 1.55). No significant difference was found in overall mortality between high risk patients treated with EVAR vs. no intervention (HR 0.42; 95% CI 0.14 - 1.26), but the aneurysm related mortality was significantly lower in the former (HR 0.30; 95% CI 0.14 - 0.63). The peri-operative mortality was higher in high risk than normal risk patients treated with EVAR (OR 2.33; 95% CI 1.75 - 3.10), as was the overall mortality (HR 3.50; 95% CI 2.55 - 4.80). The certainty of evidence was very low for EVAR vs. open surgery or no intervention and low for high vs. normal risk patients. CONCLUSION The EVAR peri-operative mortality in high risk patients has improved over time. Even though the aneurysm related mortality of EVAR is lower compared with no intervention, EVAR may confer no overall survival benefit.
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Affiliation(s)
- Nikolaos Kontopodis
- Vascular Surgery Department, Medical School, University of Crete, Heraklion, Greece
| | - Nikolaos Galanakis
- Interventiona Radiology Unit, Medical School, University of Crete, Heraklion, Greece
| | - Stavros Charalambous
- Interventiona Radiology Unit, Medical School, University of Crete, Heraklion, Greece; Department of Radiology, Division of Interventional Radiology, Nicosia General Hospital, Nicosia, Cyprus
| | - Miltiadis Matsagkas
- Vascular Surgery Department, University Hospital of Larissa, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece
| | - Athanasios D Giannoukas
- Vascular Surgery Department, University Hospital of Larissa, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece
| | - Dimitrios Tsetis
- Interventiona Radiology Unit, Medical School, University of Crete, Heraklion, Greece
| | - Christos V Ioannou
- Vascular Surgery Department, Medical School, University of Crete, Heraklion, Greece
| | - George A Antoniou
- Department of Vascular and Endovascular Surgery, Manchester University NHS Foundation Trust, Manchester, United Kingdom; Division of Cardiovascular Sciences, School of Medical Sciences, Manchester Academic Health Science Centre, The University of Manchester, Manchester, United Kingdom.
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Manolis AA, Manolis TA, Manolis AS. Patients with Polyvascular Disease: A Very High-risk Group. Curr Vasc Pharmacol 2022; 20:475-490. [PMID: 36098413 DOI: 10.2174/1570161120666220912103321] [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: 05/16/2022] [Revised: 08/04/2022] [Accepted: 08/04/2022] [Indexed: 01/25/2023]
Abstract
Polyvascular disease (PolyvascDis) with atherosclerosis occurring in >2 vascular beds (coronary, carotid, aortic, visceral and/or peripheral arteries) is encountered in 15-30% of patients who experience greater rates of major adverse cardiovascular (CV) events. Every patient with multiple CV risk factors or presenting with CV disease in one arterial bed should be assessed for PolyvascDis clinically and noninvasively prior to invasive angiography. Peripheral arterial disease (PAD) can be readily diagnosed in routine practice by measuring the ankle-brachial index. Carotid disease can be diagnosed by duplex ultrasound showing % stenosis and/or presence of plaques. Coronary artery disease (CAD) can be screened by determining coronary artery calcium score using coronary computed tomography angiography; further, non-invasive testing includes exercise stress and/or myocardial perfusion imaging or dobutamine stress test, prior to coronary angiography. Abdominal ultrasound can reveal an abdominal aortic aneurysm. Computed tomography angiography will be needed in patients with suspected mesenteric ischemia to assess the mesenteric arteries. Patients with the acute coronary syndrome and concomitant other arterial diseases have more extensive CAD and poorer CV outcomes. Similarly, PolyvascDis in patients with carotid disease and/or other PAD is independently associated with an increased risk for all-cause and CV mortality during long-term follow-up. Treatment of patients with PolyvascDis should include aggressive management of all modifiable risk factors by lifestyle changes and drug therapy, with particular attention to patients who are commonly undertreated, such as those with PAD. Revascularization should be reserved for symptomatic vascular beds, using the least aggressive strategy in a multidisciplinary vascular team approach.
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Ivanov LN, Maksimov AL, Mukhin SA, Chebotar' EV, Naumov SV, Nagaev RI, Mironov EA, Chukrin DI. [Surgical treatment of patients with abdominal aortic aneurysm and ischaemic heart disease]. ANGIOLOGII︠A︡ I SOSUDISTAI︠A︡ KHIRURGII︠A︡ = ANGIOLOGY AND VASCULAR SURGERY 2021; 27:85-93. [PMID: 34528592 DOI: 10.33529/angio2021316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Presented herein are the results of treatment of 137 patients with infrarenal aneurysms of the abdominal portion of the aorta in a combination with ischaemic heart disease. Severity of lesions to the coronary bed and the risk of cardiac complications were assessed according to the SYNTAX score. Depending on severity of angina pectoris and the clinical course of infrarenal aortic aneurysms, we used different tactical approaches to operative treatment of patients. In a low risk of coronary complications, we performed isolated prosthetic repair or endoprosthetic reconstruction of the abdominal aorta. In patients with haemodynamically significant lesions of the coronary bed and positive non-invasive tests, the first stage consisted in coronary artery bypass grafting or stenting of coronary arteries taking into account the risk of cardiac complications according to the SYNTAX Score. The second stage consisted in prosthetic repair or endoprosthetic reconstruction of the abdominal aorta. The terms of the second stage differed and were determined by the course of abdominal aortic aneurysms. In symptomatic large aneurysms (more than 8 cm), prosthetic repair of the abdominal aorta was carried out within 2 weeks after previous stenting of coronary arteries. Simultaneous myocardial revascularization and abdominal aortic reconstruction were performed only in patients with severe angina pectoris, lesions of the trunk of the left coronary artery, three-vessel lesions of the coronary bed, high risk of cardiac complications according to the SYNTAX Score and a complicated or symptomatic course of an infrarenal aortic aneurysm. During implantation of stent grafts into the abdominal aorta there were neither lethal outcomes nor cardiac complications. In open operations, the 30-day mortality rate amounted to 2.2%, with the 5-year survival rate of 92%.
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Affiliation(s)
- L N Ivanov
- Department of Hospital Surgery named after B.A. Korolev, Volga Research Medical University of the RF Ministry of Public Health, Nizhny Novgorod, Russia; Department of Vascular Surgery, Specialized Cardiosurgical Clinical Hospital named after Academician B.A. Korolev, Nizhny Novgorod, Russia
| | - A L Maksimov
- Department of Vascular Surgery, Specialized Cardiosurgical Clinical Hospital named after Academician B.A. Korolev, Nizhny Novgorod, Russia
| | - S A Mukhin
- Department of Hospital Surgery named after B.A. Korolev, Volga Research Medical University of the RF Ministry of Public Health, Nizhny Novgorod, Russia
| | - E V Chebotar'
- Department of Vascular Surgery, Specialized Cardiosurgical Clinical Hospital named after Academician B.A. Korolev, Nizhny Novgorod, Russia
| | - S V Naumov
- Department of Vascular Surgery, Specialized Cardiosurgical Clinical Hospital named after Academician B.A. Korolev, Nizhny Novgorod, Russia
| | - R Iu Nagaev
- Department of Vascular Surgery, Specialized Cardiosurgical Clinical Hospital named after Academician B.A. Korolev, Nizhny Novgorod, Russia
| | - E A Mironov
- Department of Vascular Surgery, Specialized Cardiosurgical Clinical Hospital named after Academician B.A. Korolev, Nizhny Novgorod, Russia
| | - D Iu Chukrin
- Department of Vascular Surgery, Specialized Cardiosurgical Clinical Hospital named after Academician B.A. Korolev, Nizhny Novgorod, Russia
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Natale F, Capasso R, Casalino A, Crescenzi C, Sangiuolo P, Golino P, Loffredo FS, Cimmino G. Peripheral Artery Disease and Abdominal Aortic Aneurysm: The Forgotten Diseases in COVID-19 Pandemic. Results from an Observational Study on Real-World Management. ACTA ACUST UNITED AC 2021; 57:medicina57070672. [PMID: 34209552 PMCID: PMC8307785 DOI: 10.3390/medicina57070672] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 06/11/2021] [Accepted: 06/25/2021] [Indexed: 12/24/2022]
Abstract
Background and Objectives: It is well established that patients with peripheral artery disease (PAD) as well abdominal aortic aneurysm (AAA) have an increased cardiovascular (CV) mortality. Despite this higher risk, PAD and AAA patients are often suboptimality treated. This study assessed the CV profile of PAD and AAA patients, quantifying the survival benefits of target-based risk-factors modification even in light of the COVID-19 pandemic. Materials and Methods: PAD and AAA patients admitted for any reason to the Vascular Unit from January 2019 to February 2020 were retrospectively analyzed. Biochemical and CV profiles as well as ongoing medical therapies were recorded. Benefits of CV risk-factors control were estimated using the SMART-REACH model. A follow-up visit during the year 2020 was scheduled. Results: A total of 669 patients were included. Of these, 190 showed AAA and 479 PAD at any stage. Only 54% of PAD and 41% of AAA patients were on lipid-lowering drugs with non-optimal low-density lipoprotein (LDL) levels for most of them. A better control of all modifiable CV risk-factors based on the current guidelines would offer an absolute risk reduction of the mean 10-year CV risk by 9% in PAD and 14% in AAA. Unfortunately, the follow-up visit was lost because of COVID-19 limitations. Conclusions: Lipid profiles of PAD and AAA patients were far from guideline-based targets, and medical management was suboptimal. In our center, the COVID-19 pandemic impacted on the strict surveillance required in these very high-risk patients. The achievement of guideline-based therapeutic targets would definitively confer additional significant benefits in reducing the CV risk in these patients.
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Affiliation(s)
- Francesco Natale
- Vanvitelli Cardiology and Intensive Care Unit, Monaldi Hospital, 80131 Naples, Italy; (P.G.); (F.S.L.)
- Correspondence: ; Tel.:+39-0817064239
| | - Raffaele Capasso
- Department of Translational Medical Sciences, Section of Cardiology, University of Campania “Luigi Vanvitelli”, 80131 Naples, Italy; (R.C.); (G.C.)
| | - Alfonso Casalino
- Vascular Surgery Unit, Monaldi Hospital, 80131 Naples, Italy; (A.C.); (C.C.); (P.S.)
| | - Clotilde Crescenzi
- Vascular Surgery Unit, Monaldi Hospital, 80131 Naples, Italy; (A.C.); (C.C.); (P.S.)
| | - Paolo Sangiuolo
- Vascular Surgery Unit, Monaldi Hospital, 80131 Naples, Italy; (A.C.); (C.C.); (P.S.)
| | - Paolo Golino
- Vanvitelli Cardiology and Intensive Care Unit, Monaldi Hospital, 80131 Naples, Italy; (P.G.); (F.S.L.)
- Department of Translational Medical Sciences, Section of Cardiology, University of Campania “Luigi Vanvitelli”, 80131 Naples, Italy; (R.C.); (G.C.)
| | - Francesco S. Loffredo
- Vanvitelli Cardiology and Intensive Care Unit, Monaldi Hospital, 80131 Naples, Italy; (P.G.); (F.S.L.)
- Department of Translational Medical Sciences, Section of Cardiology, University of Campania “Luigi Vanvitelli”, 80131 Naples, Italy; (R.C.); (G.C.)
- Molecular Cardiology, International Centre for Genetic Engineering and Biotechnology, 34149 Trieste, Italy
| | - Giovanni Cimmino
- Department of Translational Medical Sciences, Section of Cardiology, University of Campania “Luigi Vanvitelli”, 80131 Naples, Italy; (R.C.); (G.C.)
- Cardiology Unit, Policlinico Vanvitelli, 80138 Naples, Italy
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Li Z, Yang H, Zhang W, Wang J, Zhao Y, Cheng J. Prevalence of asymptomatic carotid artery stenosis in Chinese patients with lower extremity peripheral arterial disease: a cross-sectional study on 653 patients. BMJ Open 2021; 11:e042926. [PMID: 33931408 PMCID: PMC8098992 DOI: 10.1136/bmjopen-2020-042926] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE This study aimed to investigate the prevalence and identify predictive factors of asymptomatic carotid artery stenosis (ACAS) in Southern Chinese patients with peripheral arterial disease (PAD). DESIGN A cross-sectional study. SETTING AND PARTICIPANTS A total of 653 patients with PAD admitted to the First Affiliated Hospital of Chongqing Medical University from July 2014 to July 2019. MAIN OUTCOME MEASURES The degree of carotid stenosis was assessed by Duplex ultrasound and classified as normal (no stenosis), mild (<50% stenosis), moderate (50%-69% stenosis), severe (≥70% stenosis or near occlusion) and total occlusion. Patients with stenosis ≥50% were classified as having significant ACAS. Multivariable logistic regression analysis was used to calculate the risk associated with concomitant factors of ACAS. RESULTS The mean age was 71.5±5.5 years, and 55.9% of the patients were men. Significant ACAS stenosis accounted for 128 (19.6%) cases, including 68 (10.4%) cases of moderate stenosis (50%-69%), 46 (7.0%) cases of severe stenosis (70%-99%) and 14 (2.1%) cases of total occlusion. Multivariable analysis revealed that age ≥70 years (OR 2.0, 95% CI 1.25 to 3.18), an ankle brachial index (ABI) ≤0.5 (OR 3.39, 95% CI 1.34 to 8.55), an ABI ≤0.4 (OR 3.86, 95% CI 1.47 to 10.06) and Fontaine stage IV (OR 4.53, 95% CI 1.47 to 13.88) are predictive factors of significant ACAS. CONCLUSION The prevalence of significant ACAS (stenosis ≥50%) in patients with PAD was approximately 19.6%. Significant ACAS was more common in patients with PAD older than 70 years, particularly in patients with an ABI <0.5 and those classified as Fontaine stage IV. Selective carotid screening may be more worthwhile in these high-risk patients with PAD.
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Affiliation(s)
- Zhui Li
- Department of Vascular Surgery, the First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Hong Yang
- Departments of Ultrasound, the First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Wenfang Zhang
- Departments of Ultrasound, the First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Jing Wang
- Departments of Ultrasound, the First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yu Zhao
- Department of Vascular Surgery, the First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Jun Cheng
- Department of Vascular Surgery, the First Affiliated Hospital of Chongqing Medical University, Chongqing, China
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10
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Papadopoulos G, Kontopodis N, Marketou ME, Patrianakos A, Lioudaki S, Parthenakis FI, Ioannou CV. Analysis of Echocardiographic Markers and Pulse Wave Velocities in a Patient Who Developed New Cardiac Symptoms after Implantation of an Aortic Endograft. Ann Vasc Surg 2019; 58:381.e11-381.e16. [PMID: 30721727 DOI: 10.1016/j.avsg.2018.10.054] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2018] [Revised: 10/23/2018] [Accepted: 10/29/2018] [Indexed: 12/20/2022]
Abstract
Increased arterial stiffness has been related to altered cardiovascular hemodynamics, left ventricular hypertrophy, and a higher risk for cardiac events. Pulse wave velocity (PWV) has been used as a surrogate marker for arterial stiffness. Treatment of abdominal aortic aneurysms (AAAs) involves insertion of a rigid graft or endograft inside the arterial system which has been shown to increase arterial stiffness, but the cardiac implications of these alterations are mostly unknown. We report a case of a patient with a previous AAA surgical repair (>10 years ago) who developed a para-anastomotic pseudoaneurysm which was excluded with implantation of an endoluminal graft. From a cardiac perspective, this patient was asymptomatic and had a normal baseline preoperative evaluation. He had an initially high PWV (17 m/sec). Postprocedurally, the patient developed cardiac symptoms, and he underwent coronary angiography which indicated significant coronary artery disease, and he subsequently underwent bypass grafting. One week after the endovascular repair, the patient presented with an increased PWV at 21 m/sec. Echocardiographic indices were mostly unaltered (ejection fraction, left ventricular mass index, and left atrium volume index) compared with the preoperative evaluation, except for the global longitudinal strain which deteriorated from -25 to -21%. This case provides insight into hemodynamic alterations after implantation of an endograft which may result in deterioration of asymptomatic heart disease.
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Affiliation(s)
- George Papadopoulos
- Vascular Surgery Unit, Department of Cardiothoracic and Vascular Surgery, University Hospital of Heraklion, Heraklion, Crete, Greece
| | - Nikolaos Kontopodis
- Vascular Surgery Unit, Department of Cardiothoracic and Vascular Surgery, University Hospital of Heraklion, Heraklion, Crete, Greece
| | - Maria E Marketou
- Cardiology Department, University Hospital of Heraklion, Heraklion, Crete, Greece
| | | | - Stella Lioudaki
- Vascular Surgery Unit, Department of Cardiothoracic and Vascular Surgery, University Hospital of Heraklion, Heraklion, Crete, Greece
| | | | - Christos V Ioannou
- Vascular Surgery Unit, Department of Cardiothoracic and Vascular Surgery, University Hospital of Heraklion, Heraklion, Crete, Greece.
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Hołda MK, Iwaszczuk P, Wszołek K, Chmiel J, Brzychczy A, Trystuła M, Misztal M. Coexistence and management of abdominal aortic aneurysm and coronary artery disease. Cardiol J 2018; 27:384-393. [PMID: 30234902 DOI: 10.5603/cj.a2018.0101] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Revised: 09/07/2018] [Accepted: 07/23/2018] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND Abdominal aortic aneurysm (AAA) and coronary atherosclerosis share common risk factors. In this study, a single-center management experience of patients with a coexistence of AAA and coronary artery disease (CAD) is presented. METHODS 271 consecutive patients who underwent elective AAA repair were reviewed. Coronary imaging in 118 patients was considered suitable for exploration of AAA coexistence with CAD. RESULTS Significant coronary stenosis (> 70%) were found in 65.3% of patients. History of cardiac revascularization was present in 26.3% of patients, myocardial infarction (MI) in 31.4%, and 39.8% had both. In a subgroup analysis, prior history of percutaneous coronary intervention (PCI) (OR = 6.9, 95% CI 2.6-18.2, p < 0.001) and patients' age (OR = 1.1, 95% CI 1.0-1.2, p = 0.007) were independent predictors of significant coronary stenosis. Only 52.0% (40/77) of patients with significant coronary stenosis underwent immediate coronary revascularization prior to aneurysm repair: PCI in 32 cases (4 drug-eluting stents and 27 bare metal stents), coronary artery bypass graft in 8 cases. Patients undergoing revascularization prior to surgery had longer mean time from coronary imaging to AAA repair (123.6 vs. 58.1 days, p < 0.001). Patients undergoing coronary artery evaluation prior to AAA repair had shorter median hospitalization (7 [2-70] vs. 7 [3-181] days, p = 0.007) and intensive care unit stay (1 [0-9] vs. 1 [0-70] days, p = 0.014) and also had a lower rate of major adverse cardiovascular events or multiple organ failure (0% vs. 3.9%, p = 0.035). A total of 11.0% of patients had coronary artery aneurysms. CONCLUSIONS Patients with AAA might benefit from an early coronary artery evaluation strategy.
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Affiliation(s)
- Mateusz K Hołda
- Department of Anatomy, Faculty of Medicine, Jagiellonian University Medical College.
| | - Paweł Iwaszczuk
- Department of Cardiac and Vascular Diseases, Jagiellonian University Medical College, Kraków, Poland
| | - Karolina Wszołek
- Department of Cardiac and Vascular Diseases, Jagiellonian University Medical College, Kraków, Poland
| | - Jakub Chmiel
- Department of Cardiac and Vascular Diseases, Jagiellonian University Medical College, Kraków, Poland
| | - Andrzej Brzychczy
- Department of Vascular Surgery and Endovascular Procedures, John Paul II Hospital, Kraków, Poland
| | - Mariusz Trystuła
- Department of Vascular Surgery and Endovascular Procedures, John Paul II Hospital, Kraków, Poland
| | - Marcin Misztal
- Department of Vascular Surgery and Endovascular Procedures, John Paul II Hospital, Kraków, Poland
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12
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The Association Between Abdominal Aortic Aneurysms With Cardiovascular and Noncardiovascular Diseases. Angiology 2018; 70:8-11. [DOI: 10.1177/0003319718785790] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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13
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Spanos K, Saleptsis V, Karathanos C, Makris D, Stamoulis K, Giannoukas AD. Transition from Open Surgery to Endovascular Treatment of Abdominal Aortic Aneurysm Rupture. Ann Vasc Surg 2016; 36:85-91. [PMID: 27421198 DOI: 10.1016/j.avsg.2016.03.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2015] [Revised: 02/08/2016] [Accepted: 03/06/2016] [Indexed: 12/11/2022]
Abstract
BACKGROUND To review the outcome before and after the implementation of protocol-based strategy for endovascular repair (EVAR) of abdominal aortic aneurysm rupture (rAAA). METHODS A retrospective analysis of prospectively collected data from a tertiary center during the period 2006-2011. Demographics, comorbidities, blood examinations, perioperative patients' status, and mortality rates were recorded. Univariate and multivariate analyses were used to assess the association of the type of the procedure with various factors. RESULTS A total of 58 (46 open surgical repair [OSR] and 12 EVAR) patients with mean age of 74 ± 17 years (91% males) were treated for rAAA. However, 39 (11 EVAR and 28 OSR) were operated with protocol-based strategy available. Total mortality rate was 52.6% (10 of 19) initially and 38.5% (15 of 39) after the implementation of a protocol-based strategy. During protocol-based treatment, the survival rate did not differ between the 2 procedures (7 of 11 EVAR and 17 of 28 OSR; P, ns). A 30-day mortality rate was associated with preoperative number of platelets (unadjusted P values, P = 0.013), age (odds ratio [OR] 0.796; 95% confidence interval [CI], 0.685-0.925; P = 0.003), and diastolic blood pressure (OR, 1.053; 95% CI, 1.016-1.093; P = 0.005). After mean follow-up of 48 ± 11 months, EVAR patients presented better outcome regarding mortality rate (36% OSR vs. 0% EVAR; P = 0.0464). CONCLUSIONS After the adoption of an available rEVAR protocol-based strategy, EVAR and OSR were equally effective during postoperative 30 days. The role of hypotension and age is important on poor outcomes during this period. However, after midterm follow-up, EVAR demonstrates better survival rates than OSR.
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Affiliation(s)
- Konstantinos Spanos
- Department of Vascular Surgery, University Hospital of Larissa, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece.
| | - Vasileios Saleptsis
- Department of Vascular Surgery, University Hospital of Larissa, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece
| | - Christos Karathanos
- Department of Vascular Surgery, University Hospital of Larissa, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece
| | - Dimosthenis Makris
- Department of Intensive Care Unit, University Hospital of Larissa, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece
| | - Konstantinos Stamoulis
- Department of Anesthesiology, University Hospital of Larissa, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece
| | - Athanasios D Giannoukas
- Department of Vascular Surgery, University Hospital of Larissa, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece
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14
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Barisione C, Garibaldi S, Brunelli C, Balbi M, Spallarossa P, Canepa M, Ameri P, Viazzi F, Verzola D, Lorenzoni A, Baldassini R, Palombo D, Pane B, Spinella G, Ghigliotti G. Prevalent cardiac, renal and cardiorenal damage in patients with advanced abdominal aortic aneurysms. Intern Emerg Med 2016; 11:205-12. [PMID: 26510876 DOI: 10.1007/s11739-015-1328-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2015] [Accepted: 09/29/2015] [Indexed: 11/25/2022]
Abstract
Chronic kidney disease (CKD), cardiac damage (CD) and the combination of the two are associated with increased morbidity and death in patients admitted to vascular surgery units. We assessed the prevalence of cardiac and renal damage and cardiorenal syndrome (CRS) in 563 patients with abdominal aortic aneurysms (AAA) who underwent cardiac screening before either an endovascular procedure (EVAR) or open surgery (OS) for aneurysm repair. CD was defined by ≥stage B as per the ACC/AHA classification of congestive heart failure (CHF), while CKD was defined by estimated GFR <60 mL/min/1.73 m(2) (CKD-EPI). Anemia [World Health Organization (WHO) guidelines] and iron deficiency (ID) (criteria for CHF patients) were also calculated. AAA patients were stratified into the following groups: CD, CKD, CRS or none of these conditions [no risk factors (NoRF)]. The prevalence of isolated cardiac and renal structural damage, of combined cardiorenal damage and of ID was 24.1, 15.0, 20.6 and 23.4 %, respectively. The frequency of anemia (mostly unrecognized) among the groups increased from NoRF (12.8 %)/CKD (19 %)/CD (25 %) up to CRS (38.8 %). This large-scale observational study provides clues for the increased CD/CKD risk profiles of unselected AAA patients, and underlines the need for better identification of ID/anemia and for appropriate treatment of CKD and CD before these patients undergo EVAR/OS.
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Affiliation(s)
- Chiara Barisione
- Division of Cardiology, IRCCS San Martino University Hospital-IST, Research Center of Cardiovascular Biology, University of Genova, Viale Benedetto XV, 6., 16132, Genova, Italy
| | - Silvano Garibaldi
- Division of Cardiology, IRCCS San Martino University Hospital-IST, Research Center of Cardiovascular Biology, University of Genova, Viale Benedetto XV, 6., 16132, Genova, Italy
| | - Claudio Brunelli
- Division of Cardiology, IRCCS San Martino University Hospital-IST, Research Center of Cardiovascular Biology, University of Genova, Viale Benedetto XV, 6., 16132, Genova, Italy
| | - Manrico Balbi
- Division of Cardiology, IRCCS San Martino University Hospital-IST, Research Center of Cardiovascular Biology, University of Genova, Viale Benedetto XV, 6., 16132, Genova, Italy
| | - Paolo Spallarossa
- Division of Cardiology, IRCCS San Martino University Hospital-IST, Research Center of Cardiovascular Biology, University of Genova, Viale Benedetto XV, 6., 16132, Genova, Italy
| | - Marco Canepa
- Division of Cardiology, IRCCS San Martino University Hospital-IST, Research Center of Cardiovascular Biology, University of Genova, Viale Benedetto XV, 6., 16132, Genova, Italy
| | - Pietro Ameri
- Division of Cardiology, IRCCS San Martino University Hospital-IST, Research Center of Cardiovascular Biology, University of Genova, Viale Benedetto XV, 6., 16132, Genova, Italy
| | - Francesca Viazzi
- Department of Nephrology, IRCCS San Martino University Hospital-IST, University of Genova, Genova, Italy
| | - Daniela Verzola
- Department of Nephrology, IRCCS San Martino University Hospital-IST, University of Genova, Genova, Italy
| | - Alessandra Lorenzoni
- Division of Cardiology, IRCCS San Martino University Hospital-IST, Research Center of Cardiovascular Biology, University of Genova, Viale Benedetto XV, 6., 16132, Genova, Italy
| | - Riccardo Baldassini
- Division of Cardiology, IRCCS San Martino University Hospital-IST, Research Center of Cardiovascular Biology, University of Genova, Viale Benedetto XV, 6., 16132, Genova, Italy
| | - Domenico Palombo
- Division of Cardiology, IRCCS San Martino University Hospital-IST, Research Center of Cardiovascular Biology, University of Genova, Viale Benedetto XV, 6., 16132, Genova, Italy
| | - Bianca Pane
- Division of Cardiology, IRCCS San Martino University Hospital-IST, Research Center of Cardiovascular Biology, University of Genova, Viale Benedetto XV, 6., 16132, Genova, Italy
| | - Giovanni Spinella
- Division of Cardiology, IRCCS San Martino University Hospital-IST, Research Center of Cardiovascular Biology, University of Genova, Viale Benedetto XV, 6., 16132, Genova, Italy
| | - Giorgio Ghigliotti
- Division of Cardiology, IRCCS San Martino University Hospital-IST, Research Center of Cardiovascular Biology, University of Genova, Viale Benedetto XV, 6., 16132, Genova, Italy.
- Unit of Vascular and Endovascular Surgery, University of Genova, Genova, Italy.
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15
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Paraskevas KI, Nordon IM, Baxter SJ, Shearman CP, Phillips MJ. Abdominal Aortic Aneurysms, Peripheral Arterial Disease, and Carotid Artery Stenosis. Angiology 2015; 67:307-8. [DOI: 10.1177/0003319715594932] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Kosmas I. Paraskevas
- Department of Vascular Surgery, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
| | - Ian M. Nordon
- Department of Vascular Surgery, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
| | - Stephen J. Baxter
- Department of Vascular Surgery, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
| | - Clifford P. Shearman
- Department of Vascular Surgery, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
| | - Mike J. Phillips
- Department of Vascular Surgery, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
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