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;" : ABDOMINAL AORTIC ANEURYSMS
Natzi Sakalihasan1,2, Jean-Olivier Defraigne1,2, Athanasios Katsargyris3, Helena Kuivaniemi4, Jean-Baptiste Michel5, Alain Nchimi 2,6, Janet Powell7, Koichi Yoshimura8,9, Rebecka Hultgren10, 11
1Department of Cardiovascular and Thoracic Surgery, CHU Lige, University of Lige, Lige, Belgium;
2Surgical Research Center, GIGA-Cardiovascular Science Unit, University of Lige, Lige, Belgium;
3Department of Vascular and Endovascular Surgery, Paracelsus Medical University, Nuremberg, Germany;
4Division of Molecular Biology and Human Genetics, Department of Biomedical Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa;
5UMR 1148, Inserm Paris 7, Denis Diderot University, Xavier Bichat Hospital, Paris, France;
6Department of Medical Imaging Centre Hospitalier de Luxembourg , Luxembourg;
7Vascular Surgery Research Group, Imperial College London, UK;
8Graduate School of Health and Welfare, Yamaguchi Prefectural University, Yamaguchi, Japan;
9Department of Surgery and Clinical Science, Yamaguchi University Graduate School of Medicine, Ube, Japan;
10 Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
11. Department of Vascular Surgery, Karolinska University Hospital, Stockholm, Sweden.
Correspondence to:
N. S.
nsaka@chu.ulg.ac.be
Acknowledgements
We thank Audrey Courtois for her help during the preparation of this manuscript and Pierre Bonet for figures on surgical management of AAA.
Author contributions
Introduction (N.S. and J.T.P.); Epidemiology (R.H.); Mechanisms/pathophysiology (J.-O.D., H.K. and J.-B.M.); Diagnosis, screening and prevention (N.S., A.N. and R.H.); Management (N.S., A.K., K.Y. and R.H.); Quality of life (A.K. and J.T.P.); Outlook (N.S., H.K. and J.T.P.); Overview of Primer (N.S. R.H).
Competing interests
All authors declare no competing interests.
Abstract
An Abdominal Aortic Aneurysm (AAA) is a localized dilatation of the infrarenal aorta. It is a common vascular disease, with a higher prevalence in aging men than in women
It is probable that a true global difference in prevalence of AAA between different ethnic groups exists, but an underestimation of prevalence can depend on mean life-expectancy and limited access to radiology in some regions. Three phases are distinguished in disease progression; development, growth and rupture. The most important risk factors are smoking, male sex and family history, whereas interestingly, diabetes mellitus is a negative risk factor for AAA. AAA is a multifactorial disease, and genetic factors play an important part in the development of AAA. Aneurysmal growth is related to increased metabolic activity in both the aneurysmal wall and the intraluminal thrombus. Rupture occurs when the mechanical stress acting on the wall exceeds the wall strength, with rupture of the aneurysm causing intraabdominal hemorrhage. The mortality for patients with ruptured AAA is 6 5 "8 5 % a n d a b o u t h a l f d i e b e f o r e b e i n g a d m i t t e d t o h o s p i t a l . A l t h o u g h r u p t u r e c a n o c c u r i n s m a l l A A A , t h e r i s k o f r u p t u r e i n c r e a s e s w i t h t h e d i a m e t e r o f t h e a n e u r y s m . M o d e r n f u n c t i o n a l i m a g i n g t e c h n i q u e s m a y h e l p t o a s s e s s r u p t u r e r i s k . A l t h o u g h r e s u l t s f or elective repair have improved over the last decades, there remains a non-negligible morbidity and mortality associated with aortic surgery. There is a growing body of evidence from randomized clinical trials concerning improved detection and management of AAA, including population screening for men, but the underlying prevalence in local population and local population longevity must be considered before this is implemented.
Introduction
An aneurysm is defined as a permanent and irreversible localized dilatation of a vessel. This abnormal dilatation involves all three layers of the vascular wall: the intima, the media and the adventitia (Fig 1). This definition differentiates an aneurysm sensu stricto from a false aneurysm or pseudoaneurysm, which is a dilatation secondary to a vessel rupture. The outer wall of the pseudoaneurysm, is a fibrous material devoid of any vascular structures, not a vessel wall or adventitia. Similarly, the infiltration of blood within the vascular wall, with an enlargement of the external dimensions of the artery, such as one seen in dissecting aneurysm, is not an aneurysm in the strict meaning of the term.
MorphologicallyADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "author" : [ { "dropping-particle" : "", "family" : "Slaney", "given" : "G", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "The cause and Management of Aneurysm", "edition" : "WB Saunder", "editor" : [ { "dropping-particle" : "", "family" : "Greenhalgh", "given" : "R M", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Mannick", "given" : "J A", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "id" : "ITEM-1", "issued" : { "date-parts" : [ [ "1990" ] ] }, "page" : "1-19", "title" : "A history of aneurysm surgery", "type" : "chapter" }, "uris" : [ "http://www.mendeley.com/documents/?uuid=548239a5-e0a3-4775-9fb1-1bf29fa6d18a" ] } ], "mendeley" : { "formattedCitation" : "1", "plainTextFormattedCitation" : "1", "previouslyFormattedCitation" : "1" }, "properties" : { }, "schema" : "https://github.com/citation-style-language/schema/raw/master/csl-citation.json" }1 aneurysms can be described as fusiform if the whole circumference of the artery is part of the aneurysmal dilatation, whereas an aneurysm is called saccular if it involves only a part of the circumference, the majority of AAA are fusiform. ( FIGURE 1)
Aneurysms are functionally defined by progressive changes in the arterial wall in response to changes in arterial pressure, leading to thinning of the wall, with the degradation of extracellular matrix (ECM) and loss of vascular smooth muscle cells (v-SMCs), which increases the susceptibility to rupture.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "cvq337 [pii]\r10.1093/cvr/cvq337", "ISBN" : "1755-3245 (Electronic)\r0008-6363 (Linking)", "PMID" : "21037321", "abstract" : "Aneurysm of the abdominal aorta (AAA) is a particular, specifically localized form of atherothrombosis, providing a unique human model of this disease. The pathogenesis of AAA is characterized by a breakdown of the extracellular matrix due to an excessive proteolytic activity, leading to potential arterial wall rupture. The roles of matrix metalloproteinases and plasmin generation in progression of AAA have been demonstrated both in animal models and in clinical studies. In the present review, we highlight recent studies addressing the role of the haemoglobin-rich, intraluminal thrombus and the adventitial response in the development of human AAA. The intraluminal thrombus exerts its pathogenic effect through platelet activation, fibrin formation, binding of plasminogen and its activators, and trapping of erythrocytes and neutrophils, leading to oxidative and proteolytic injury of the arterial wall. These events occur mainly at the intraluminal thrombus-circulating blood interface, and pathological mediators are conveyed outwards, where they promote matrix degradation of the arterial wall. In response, neo-angiogenesis, phagocytosis by mononuclear cells, and a shift from innate to adaptive immunity in the adventitia are observed. Abdominal aortic aneurysm thus represents an accessible spatiotemporal model of human atherothrombotic progression towards clinical events, the study of which should allow further understanding of its pathogenesis and the translation of pathogenic biological activities into diagnostic and therapeutic applications.", "author" : [ { "dropping-particle" : "", "family" : "Michel", "given" : "J B", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Martin-Ventura", "given" : "J L", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Egido", "given" : "J", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Sakalihasan", "given" : "N", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Treska", "given" : "V", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Lindholt", "given" : "J", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Allaire", "given" : "E", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Thorsteinsdottir", "given" : "U", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Cockerill", "given" : "G", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Swedenborg", "given" : "J", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Cardiovasc Res", "edition" : "2010/11/03", "id" : "ITEM-1", "issue" : "1", "issued" : { "date-parts" : [ [ "2011" ] ] }, "language" : "eng", "note" : "Michel, Jean-Baptiste\nMartin-Ventura, Jose-Luis\nEgido, Jesus\nSakalihasan, Natzi\nTreska, Vladislav\nLindholt, Jes\nAllaire, Eric\nThorsteinsdottir, Unnur\nCockerill, Gillian\nSwedenborg, Jesper\nFAD EU consortium\nResearch Support, Non-U.S. Gov't\nReview\nEngland\nCardiovascular research\nCardiovasc Res. 2011 Apr 1;90(1):18-27. Epub 2010 Oct 30.", "page" : "18-27", "title" : "Novel aspects of the pathogenesis of aneurysms of the abdominal aorta in humans", "type" : "article-journal", "volume" : "90" }, "uris" : [ "http://www.mendeley.com/documents/?uuid=d88d0cf8-809c-481c-8e63-8e26812c898b" ] } ], "mendeley" : { "formattedCitation" : "77", "plainTextFormattedCitation" : "77", "previouslyFormattedCitation" : "77" }, "properties" : { }, "schema" : "https://github.com/citation-style-language/schema/raw/master/csl-citation.json" }77
The most common site for aneurysm development is in the infrarenal aorta, called abdominal aortic aneurysms (AAA). There is no unanimity on the definition of AAA. In 1991, the Society for Vascular Surgery and the International Society for Cardiovascular Surgery Ad Hoc Committee on Standards in Reporting proposed that when the infrarenal diameter is 1.5 times the expected normal diameter it should be called an AAA.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "ISBN" : "0741-5214 (Print)\r0741-5214 (Linking)", "PMID" : "1999868", "abstract" : "The literature on arterial aneurysms is subject to potential misinterpretation because of inconsistencies in reporting standards. The joint councils of the Society for Vascular Surgery and the North American Chapter of the International Society for Cardiovascular Surgery appointed an ad hoc committee to address this issue. This communication, prepared in response to the need for standardized reporting, defines and classifies arterial aneurysms and recommends standards for describing the causes, manifestations, treatment, and outcome criteria that are important when publishing data on aneurysmal disease.", "author" : [ { "dropping-particle" : "", "family" : "Johnston", "given" : "K W", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Rutherford", "given" : "R B", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Tilson", "given" : "M D", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Shah", "given" : "D M", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Hollier", "given" : "L", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Stanley", "given" : "J C", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "J Vasc Surg", "id" : "ITEM-1", "issue" : "3", "issued" : { "date-parts" : [ [ "1991" ] ] }, "note" : "Johnston, K W\nRutherford, R B\nTilson, M D\nShah, D M\nHollier, L\nStanley, J C\neng\nGuideline\n1991/03/01 00:00\nJ Vasc Surg. 1991 Mar;13(3):452-8.", "page" : "452-458", "title" : "Suggested standards for reporting on arterial aneurysms. Subcommittee on Reporting Standards for Arterial Aneurysms, Ad Hoc Committee on Reporting Standards, Society for Vascular Surgery and North American Chapter, International Society for Cardiovascular", "type" : "article-journal", "volume" : "13" }, "uris" : [ "http://www.mendeley.com/documents/?uuid=9d5cee1e-4ff7-434e-ab47-76deebc4f5a6" ] } ], "mendeley" : { "formattedCitation" : "3", "plainTextFormattedCitation" : "3", "previouslyFormattedCitation" : "3" }, "properties" : { }, "schema" : "https://github.com/citation-style-language/schema/raw/master/csl-citation.json" }3 However, in clinical practice, the infrarenal abdominal aorta is considered aneurysmal if the aortic d i a m e t e r i s e"3 0 m m a s p r o p o s e d b y M c G r e g o r a n d c o l l e a g u e s . A D D I N C S L _ C I T A T I O N { " c i t a t i o n I t e m s " : [ { " i d " : " I T E M - 1 " , " i t e m D a t a " : { " I S B N " : " 0 0 3 6 - 9 3 3 0 ( P r i n t ) 0 0 3 6 - 9 3 3 0 ( L i n k i n g ) " , " P M I D " : " 1 1 8 8 3 5 0 " , " a b s t r a c t " : " A n e v a l u a t i o n o f u l t r a s o n o g r a p h y i n e a r ly dilatation and aneurysm is presented. Fifty-nine patients with prominent abdominal pulsation were examined and aneurysm was demonstrated in 22. There was a high degree of correlation between the size of the aneurysm demonstrated by ultrasound and the size displayed at operation. It was also possible to demonstrate increasing dilatation by measurement on subsequent occasions.", "author" : [ { "dropping-particle" : "", "family" : "McGregor", "given" : "J C", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Pollock", "given" : "J G", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Anton", "given" : "H C", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Scott Med J", "edition" : "1975/05/01", "id" : "ITEM-1", "issue" : "3", "issued" : { "date-parts" : [ [ "1975" ] ] }, "language" : "eng", "note" : "McGregor, J C\nPollock, J G\nAnton, H C\nScotland\nScottish medical journal\nScott Med J. 1975 May;20(3):133-7.", "page" : "133-137", "title" : "The value of ultrasonography in the diagnosis of abdominal aortic aneurysm", "type" : "article-journal", "volume" : "20" }, "uris" : [ "http://www.mendeley.com/documents/?uuid=75b6134e-b3d0-4a34-8ecb-7125754521f2" ] } ], "mendeley" : { "formattedCitation" : "4", "plainTextFormattedCitation" : "4", "previouslyFormattedCitation" : "4" }, "properties" : { }, "schema" : "https://github.com/citation-style-language/schema/raw/master/csl-citation.json" }4 When reporting a dilatation of the diameter of the infrarenal aorta in a patient, the diameter of the normal adjacent aorta should be taken into consideration, but in clinical practice this is not always feasible. ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "ISBN" : "0002-9580 (Print)\r0002-9580 (Linking)", "PMID" : "5844934", "author" : [ { "dropping-particle" : "", "family" : "Steinberg", "given" : "C R", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Archer", "given" : "M", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Steinberg", "given" : "I", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Am J Roentgenol Radium Ther Nucl Med", "id" : "ITEM-1", "issue" : "3", "issued" : { "date-parts" : [ [ "1965" ] ] }, "note" : "Steinberg, C R\nArcher, M\nSteinberg, I\neng\n1965/11/01 00:00\nAm J Roentgenol Radium Ther Nucl Med. 1965 Nov;95(3):703-8.", "page" : "703-708", "title" : "Measurement of the abdominal aorta after intravenous aortography in health and arteriosclerotic peripheral vascular disease", "type" : "article-journal", "volume" : "95" }, "uris" : [ "http://www.mendeley.com/documents/?uuid=1a4e1a88-1953-4bf3-b5ef-7738e846828d" ] } ], "mendeley" : { "formattedCitation" : "2", "plainTextFormattedCitation" : "2", "previouslyFormattedCit a t i o n " : " < s u p > 2 < / s u p > " } , " p r o p e r t i e s " : { } , " s c h e m a " : " h t t p s : / / g i t h u b . c o m / c i t a t i o n - s t y l e - l a n g u a g e / s c h e m a / r a w / m a s t e r / c s l - c i t a t i o n . j s o n " } 2 T h e d i l a t a t i o n o f t h e a o r t a s h o u l d b e m e a s u r e d i n b o t h a n t e r i o r - p o s t e r i o r a n d t r a n s v e r s e d i r e c t i o n s . T h e e"3 0 m m definition might not be appropriate for women, who have smaller diameter arteries than men.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1016/j.amjcard.2013.01.306", "ISBN" : "1879-1913 (Electronic)\r0002-9149 (Linking)", "PMID" : "23497775", "abstract" : "Current screening and detection of asymptomatic aortic aneurysms is based largely on uniform cut-point diameters. The aims of this study were to define normal aortic diameters in asymptomatic men and women in a community-based cohort and to determine the association between aortic diameters and traditional risk factors for cardiovascular disease. Measurements of the diameters of the ascending thoracic aorta (AA), descending thoracic aorta (DTA), infrarenal abdominal aorta (IRA), and lower abdominal aorta (LAA) were acquired from 3,431 Framingham Heart Study (FHS) participants. Mean diameters were stratified by gender, age, and body surface area. Univariate associations with risk factor levels were examined, and multivariate linear regression analysis was used to assess the significance of covariate-adjusted relations with aortic diameters. For men, the average diameters were 34.1 mm for the AA, 25.8 mm for the DTA, 19.3 mm for the IRA, and 18.7 mm for the LAA. For women, the average diameters were 31.9 mm for the AA, 23.1 mm for the DTA, 16.7 mm for the IRA, and 16.0 mm for the LAA. The mean aortic diameters were strongly correlated (p <0.0001) with age and body surface area in age-adjusted analyses, and these relations remained significant in multivariate regression analyses. Positive associations of diastolic blood pressure with AA and DTA diameters in both genders and pack-years of cigarette smoking with DTA diameter in women and IRA diameter in men and women were observed. In conclusion, average diameters of the thoracic and abdominal aorta by computed tomography are larger in men compared with women, vary significantly with age and body surface area, and are associated with modifiable cardiovascular disease risk factors, including diastolic blood pressure and cigarette smoking.", "author" : [ { "dropping-particle" : "", "family" : "Rogers", "given" : "I S", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Massaro", "given" : "J M", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Truong", "given" : "Q A", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Mahabadi", "given" : "A A", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Kriegel", "given" : "M F", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Fox", "given" : "C S", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Thanassoulis", "given" : "G", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Isselbacher", "given" : "E M", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Hoffmann", "given" : "U", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "O'Donnell", "given" : "C J", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Am J Cardiol", "id" : "ITEM-1", "issue" : "10", "issued" : { "date-parts" : [ [ "2013" ] ] }, "note" : "Rogers, Ian S\nMassaro, Joseph M\nTruong, Quynh A\nMahabadi, Amir A\nKriegel, Matthias F\nFox, Caroline S\nThanassoulis, George\nIsselbacher, Eric M\nHoffmann, Udo\nO'Donnell, Christopher J\neng\nN01-HC-25195/HC/NHLBI NIH HHS/\nZIA HL006002-05/Intramural NIH HHS/\nT32 HL076136/HL/NHLBI NIH HHS/\n1T32 HL076136/HL/NHLBI NIH HHS/\nL30 HL093806/HL/NHLBI NIH HHS/\nN01HC25195/HL/NHLBI NIH HHS/\nK23 HL098370/HL/NHLBI NIH HHS/\nZIA HL006002-04/Intramural NIH HHS/\nComparative Study\nResearch Support, N.I.H., Extramural\nResearch Support, Non-U.S. Gov't\n2013/03/19 06:00\nAm J Cardiol. 2013 May 15;111(10):1510-6. doi: 10.1016/j.amjcard.2013.01.306. Epub 2013 Mar 13.", "page" : "1510-1516", "title" : "Distribution, determinants, and normal reference values of thoracic and abdominal aortic diameters by computed tomography (from the Framingham Heart Study)", "type" : "article-journal", "volume" : "111" }, "uris" : [ "http://www.mendeley.com/documents/?uuid=89748af2-142d-4b58-b161-a71c3b69cd11" ] } ], "mendeley" : { "formattedCitation" : "5", "plainTextFormattedCitation" : "5", "previouslyFormattedCitation" : "5" }, "properties" : { }, "schema" : "https://github.com/citation-style-language/schema/raw/master/csl-citation.json" }5 Based on the diameter of the aorta, AAA can be classified as small (<40 mm), medium (40-55 mm) or large (>55 mm).
AAA enlarge gradually and as the size increases, so does the risk of rupture. When an AAA ruptures, patients suffers from massive intraabdominal hemorrhage. This condition, if left untreated, results in 100 % mortality. Since most patients with AAA are asymptomatic this is commonly an undiagnosed condition. Only by incidental or systematic screening of risk groups one can prevent aneurysm-related death. For this reason, most patients diagnosed with large AAAs are offered a repair, where the enlarged aorta is replaced or relined with a tube of synthetic material.
This review will give a contemporary overview of the pathogenesis, diagnosis, treatment and outcome of patients with AAA, but will only briefly touch upon aneurysms in other arteries, such as thoracic aneurysms.
[H1] Epidemiology
[H2] Disease burden
In developed countries, and globally the prevalence and incidence of AAA has decreased during the last two decades, but in some areas such as Latin America and high income Asia Pacific the prevalence is possibly increasing.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1016/j.gheart.2013.12.009", "ISSN" : "22118160", "PMID" : "25432125", "abstract" : "The global burden of abdominal aortic aneurysm (AAA) has not been studied previously. Such information is important given the emergence of cardiovascular diseases in developing countries. We conducted a systematic literature review and estimated the global and regional incidence and prevalence of AAA in 21 world regions by age and sex. The search for prevalence and incidence of AAA using standard clinical and epidemiological terms was conducted using MEDLINE (1950 to 2010), EMBASE (1980 to 2010), AMED (1985 to 2010), CINAHL (1982 to 2010), and LILACS (2008 to 2010). Data abstracted from the systematic review served as priors for Bayesian meta-regression analyses. The analysis drew from 26 high-quality studies to estimate AAA prevalence and incidence. In 1990, the global age-specific prevalence rate per 100,000 ranged from 8.43 (95% CI: 7.03 to 10.14) in the 40 to 44 years age group to 2,422.53 (95% CI: 2,298.63 to 2,562.25) in the 75 to 79 years age group; the corresponding range in 2010 was 7.88 (95% CI: 6.54 to 9.59) to 2,274.82 (95% CI: 2,149.77 to 2,410.17). Prevalence was higher in developed versus developing nations, and the rates within each development stratum decreased between 1990 and 2010. Globally, the age-specific annual incidence rate per 100,000 in 1990 ranged from 0.89 (95% CI: 0.66 to 1.17) in 40 to 44 years age group to 176.08 (95% CI: 162.72 to 190.28) in the 75 to 79 years age group. In 2010, this range was 0.83 (95% CI: 0.61 to 1.11) to 164.57 (95% CI: 152.20 to 178.78). The highest prevalence in 1990 was in Australasia and North America high income regions: 382.65 (95% CI: 356.27 to 410.88) and 300.59 (95% CI: 280.93 to 321.54), respectively. Australasia had the highest prevalence in 2010, although the prevalence decreased to 310.27 (95% CI: 289.01 to 332.94). Regional prevalence increased in Oceania, tropical Latin America, Asia Pacific high income, Southern Sub-Saharan Africa (SSA), Central SSA, South Asia, Western SSA, and Central Asia. AAA global prevalence and incidence rates have decreased over the last 20 years. However, rising rates in some regions highlight the need for policies to enhance global disease surveillance and prevention.", "author" : [ { "dropping-particle" : "", "family" : "Sampson", "given" : "Uchechukwu K.A.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Norman", "given" : "Paul E.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Fowkes", "given" : "F. Gerald R.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Aboyans", "given" : "Victor", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Song", "given" : "Yanna", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Harrell", "given" : "Frank E.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Forouzanfar", "given" : "Mohammad H.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Naghavi", "given" : "Mohsen", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Denenberg", "given" : "Julie O.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "McDermott", "given" : "Mary M.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Criqui", "given" : "Michael H.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Mensah", "given" : "George A.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Ezzati", "given" : "Majid", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Murray", "given" : "Christopher", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Global Heart", "id" : "ITEM-1", "issue" : "1", "issued" : { "date-parts" : [ [ "2014", "3" ] ] }, "page" : "159-170", "title" : "Estimation of Global and Regional Incidence and Prevalence of Abdominal Aortic Aneurysms 1990 to 2010", "type" : "article-journal", "volume" : "9" }, "uris" : [ "http://www.mendeley.com/documents/?uuid=298f4e3e-d626-306e-a2ae-6cff43bcefdf" ] } ], "mendeley" : { "formattedCitation" : "6", "plainTextFormattedCitation" : "6", "previouslyFormattedCitation" : "6" }, "properties" : { }, "schema" : "https://github.com/citation-style-language/schema/raw/master/csl-citation.json" }6 The prevalence also varies worldwide between ethnic groups and between sexes. The decline in prevalence for men in the western world is best observed in population-based screening programmes.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1002/bjs.8984", "ISBN" : "1365-2168 (Electronic)\r0007-1323 (Linking)", "PMID" : "23192439", "abstract" : "BACKGROUND: Screening elderly men for abdominal aortic aneurysm (AAA) to reduce mortality from rupture is evidence-based. For women epidemiological data on AAA are scarce, and the evidence for screening is insufficient. The aim of this population-based study was to determine the current prevalence of AAA and risk factors among 70-year-old women. METHODS: All 70-year-old women identified through the National Population Registry in the two neighbouring counties of Uppsala and Dalarna were invited to a free ultrasound examination of the abdominal aorta. An AAA was defined as a maximum infrarenal aortic diameter of at least 30 mm. RESULTS: Of 6925 women invited, 5140 (74.2 per cent) accepted the invitation to be screened. Among these, 19 AAAs were detected (0.4 (95 per cent confidence interval (c.i.) 0.2 to 0.5) per cent). In the invited cohort 12 women (0.2 (0.1 to 0.3) per cent) had undergone previous AAA repair (11) or had a known AAA under surveillance (1). Thus, the total prevalence was estimated at 0.5 (0.4 to 0.7) per cent. Smoking was strongly associated with AAA; 18 (95 per cent) of 19 women with a screen-detected AAA had a history of smoking compared with 44.2 per cent of those with a normal aorta (odds ratio 20.29, 95 per cent c.i. 2.70 to 152.65). The prevalence of AAA was 0.03 (0 to 0.1) per cent among never smokers, 0.4 (0.2 to 0.8) per cent among former smokers and 2.1 (1.0 to 3.7) per cent among current smokers. CONCLUSION: Screening 70-year-old women who do not smoke is likely to be futile, thus ruling out population screening of women for AAA.", "author" : [ { "dropping-particle" : "", "family" : "Svensjo", "given" : "S", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Bjorck", "given" : "M", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Wanhainen", "given" : "A", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Br J Surg", "id" : "ITEM-1", "issue" : "3", "issued" : { "date-parts" : [ [ "2013" ] ] }, "note" : "Svensjo, S\nBjorck, M\nWanhainen, A\neng\nResearch Support, Non-U.S. Gov't\nEngland\n2012/11/30 06:00\nBr J Surg. 2013 Feb;100(3):367-72. doi: 10.1002/bjs.8984. Epub 2012 Nov 28.", "page" : "367-372", "title" : "Current prevalence of abdominal aortic aneurysm in 70-year-old women", "type" : "article-journal", "volume" : "100" }, "uris" : [ "http://www.mendeley.com/documents/?uuid=3755a4ba-b759-4a88-906b-7e2c84ec12b1" ] }, { "id" : "ITEM-2", "itemData" : { "DOI" : "10.1002/bjs.10715", "ISBN" : "1365-2168 (Electronic)\r0007-1323 (Linking)", "PMID" : "29265406", "abstract" : "BACKGROUND: This study aimed to assess how the prevalence and growth rates of small and medium abdominal aortic aneurysms (AAAs) (3.0-5.4 cm) have changed over time in men aged 65 years, and to evaluate long-term outcomes in men whose aortic diameter is 2.6-2.9 cm (subaneurysmal), and below the standard threshold for most surveillance programmes. METHODS: The Gloucestershire Aneurysm Screening Programme (GASP) started in 1990. Men aged 65 years with an aortic diameter of 2.6-5.4 cm, measured by ultrasonography using the inner to inner wall method, were included in surveillance. Aortic diameter growth rates were estimated separately for men who initially had a subaneurysmal aorta, and those who had a small or medium AAA, using mixed-effects models. RESULTS: Since 1990, 81 150 men had ultrasound screening for AAA (uptake 80.7 per cent), of whom 2795 had an aortic diameter of 2.6-5.4 cm. The prevalence of screen-detected AAA of 3.0 cm or larger decreased from 5.0 per cent in 1991 to 1.3 per cent in 2015. There was no evidence of a change in AAA growth rates during this time. Of men who initially had a subaneurysmal aorta, 57.6 (95 per cent c.i. 54.4 to 60.7) per cent were estimated to develop an AAA of 3.0 cm or larger within 5 years of the initial scan, and 28.0 (24.2 to 31.8) per cent to develop a large AAA (at least 5.5 cm) within 15 years. CONCLUSION: The prevalence of screen-detected small and medium AAAs has decreased over the past 25 years, but growth rates have remained similar. Men with a subaneurysmal aorta at age 65 years have a substantial risk of developing a large AAA by the age of 80 years.", "author" : [ { "dropping-particle" : "", "family" : "Oliver-Williams", "given" : "C", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Sweeting", "given" : "M J", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Turton", "given" : "G", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Parkin", "given" : "D", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Cooper", "given" : "D", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Rodd", "given" : "C", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Thompson", "given" : "S G", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Earnshaw", "given" : "J J", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Gloucestershire", "given" : "", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Swindon Abdominal Aortic Aneurysm Screening", "given" : "Programme", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Br J Surg", "id" : "ITEM-2", "issue" : "1", "issued" : { "date-parts" : [ [ "2018" ] ] }, "note" : "Oliver-Williams, C\nSweeting, M J\nTurton, G\nParkin, D\nCooper, D\nRodd, C\nThompson, S G\nEarnshaw, J J\neng\nEngland\n2017/12/22 06:00\nBr J Surg. 2018 Jan;105(1):68-74. doi: 10.1002/bjs.10715.", "page" : "68-74", "title" : "Lessons learned about prevalence and growth rates of abdominal aortic aneurysms from a 25-year ultrasound population screening programme", "type" : "article-journal", "volume" : "105" }, "uris" : [ "http://www.mendeley.com/documents/?uuid=67612048-6c73-43f5-896a-6a7221a7aaba" ] }, { "id" : "ITEM-3", "itemData" : { "DOI" : "10.1002/bjs.9825", "ISBN" : "1365-2168 (Electronic)\r0007-1323 (Linking)", "PMID" : "25923784", "abstract" : "BACKGROUND: Abdominal aortic aneurysm (AAA) screening has been introduced into some health systems and could easily be supplemented with broader vascular screening. The aim of this study was to evaluate the screening set-up and investigate combined screening for AAA, peripheral arterial disease (PAD) and possible hypertension (HT), and detection rates. METHODS: This observational study was based on the intervention arm of a screening trial in 25 083 Danish men aged 65-74 years. A combined screening programme for AAA, PAD and HT was offered at local hospitals. Participants with positive test results were offered secondary prophylaxis and/or referred to their general practitioner. The programme set-up included decentralized screening by three mobile teams at 14 venues. Diagnostic criteria were: aortic diameter at least 30 mm for AAA, ankle : brachial pressure index below 0.9 or above 1.4 for PAD, and BP exceeding 160/100 mmHg for HT. RESULTS: Overall, 18 749 men (uptake 74.7 per cent) attended the screening. An AAA was diagnosed in 3.3 (95 per cent c.i. 3.0 to 3.6) per cent, PAD in 10.9 (10.5 to 11.4) per cent and HT in 10.5 (10.0 to 10.9) per cent. Lipid-lowering and/or antiplatelet treatment was initiated in 34.8 per cent of the participants. CONCLUSION: Preventive actions were started in one-third of the attenders. The long-term effect of this on morbidity and mortality is an important part of future analysis. The trial confirms that the prevalence of AAA in Denmark has decreased only slightly in the past decade, from 4.0 to 3.3 per cent, in contrast to other nations.", "author" : [ { "dropping-particle" : "", "family" : "Grondal", "given" : "N", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Sogaard", "given" : "R", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Lindholt", "given" : "J S", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Br J Surg", "id" : "ITEM-3", "issue" : "8", "issued" : { "date-parts" : [ [ "2015" ] ] }, "note" : "Grondal, N\nSogaard, R\nLindholt, J S\neng\nObservational Study\nResearch Support, Non-U.S. Gov't\nEngland\n2015/04/30 06:00\nBr J Surg. 2015 Jul;102(8):902-6. doi: 10.1002/bjs.9825. Epub 2015 Apr 28.", "page" : "902-906", "title" : "Baseline prevalence of abdominal aortic aneurysm, peripheral arterial disease and hypertension in men aged 65-74 years from a population screening study (VIVA trial)", "type" : "article-journal", "volume" : "102" }, "uris" : [ "http://www.mendeley.com/documents/?uuid=9a782558-3a4d-490e-a1a1-9ee72f713379" ] } ], "mendeley" : { "formattedCitation" : "7\u20139", "plainTextFormattedCitation" : "7\u20139", "previouslyFormattedCitation" : "7\u20139" }, "properties" : { }, "schema" : "https://github.com/citation-style-language/schema/raw/master/csl-citation.jso n " } 7 9 T h e m o r e r e c e n t u l t r a s o n o g r a p h y b a s e d s c r e e n i n g s t u d i e s d i a g n o s e s A A A i n 1 - 2 % o f a l l 6 5 "y e a r - o l d m e n a n d i n 0 . 5 % o f 7 0 "y e a r - o l d w o m e n . S o m e p e r s o n s i n t h e p o p u l a t i o n a r e d i a g n o s e d o u t s i d e t h e p r o g r a m s , t r e a t e d b e f o r e 6 5 y e a r s , o r n o n - p a r t i c i p a n ts which would slightly increase the true prevalence in the population.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1002/bjs.8984", "ISBN" : "1365-2168 (Electronic)\r0007-1323 (Linking)", "PMID" : "23192439", "abstract" : "BACKGROUND: Screening elderly men for abdominal aortic aneurysm (AAA) to reduce mortality from rupture is evidence-based. For women epidemiological data on AAA are scarce, and the evidence for screening is insufficient. The aim of this population-based study was to determine the current prevalence of AAA and risk factors among 70-year-old women. METHODS: All 70-year-old women identified through the National Population Registry in the two neighbouring counties of Uppsala and Dalarna were invited to a free ultrasound examination of the abdominal aorta. An AAA was defined as a maximum infrarenal aortic diameter of at least 30 mm. RESULTS: Of 6925 women invited, 5140 (74.2 per cent) accepted the invitation to be screened. Among these, 19 AAAs were detected (0.4 (95 per cent confidence interval (c.i.) 0.2 to 0.5) per cent). In the invited cohort 12 women (0.2 (0.1 to 0.3) per cent) had undergone previous AAA repair (11) or had a known AAA under surveillance (1). Thus, the total prevalence was estimated at 0.5 (0.4 to 0.7) per cent. Smoking was strongly associated with AAA; 18 (95 per cent) of 19 women with a screen-detected AAA had a history of smoking compared with 44.2 per cent of those with a normal aorta (odds ratio 20.29, 95 per cent c.i. 2.70 to 152.65). The prevalence of AAA was 0.03 (0 to 0.1) per cent among never smokers, 0.4 (0.2 to 0.8) per cent among former smokers and 2.1 (1.0 to 3.7) per cent among current smokers. CONCLUSION: Screening 70-year-old women who do not smoke is likely to be futile, thus ruling out population screening of women for AAA.", "author" : [ { "dropping-particle" : "", "family" : "Svensjo", "given" : "S", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Bjorck", "given" : "M", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Wanhainen", "given" : "A", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Br J Surg", "id" : "ITEM-1", "issue" : "3", "issued" : { "date-parts" : [ [ "2013" ] ] }, "note" : "Svensjo, S\nBjorck, M\nWanhainen, A\neng\nResearch Support, Non-U.S. Gov't\nEngland\n2012/11/30 06:00\nBr J Surg. 2013 Feb;100(3):367-72. doi: 10.1002/bjs.8984. Epub 2012 Nov 28.", "page" : "367-372", "title" : "Current prevalence of abdominal aortic aneurysm in 70-year-old women", "type" : "article-journal", "volume" : "100" }, "uris" : [ "http://www.mendeley.com/documents/?uuid=3755a4ba-b759-4a88-906b-7e2c84ec12b1" ] }, { "id" : "ITEM-2", "itemData" : { "DOI" : "10.1002/bjs.9825", "ISBN" : "1365-2168 (Electronic)\r0007-1323 (Linking)", "PMID" : "25923784", "abstract" : "BACKGROUND: Abdominal aortic aneurysm (AAA) screening has been introduced into some health systems and could easily be supplemented with broader vascular screening. The aim of this study was to evaluate the screening set-up and investigate combined screening for AAA, peripheral arterial disease (PAD) and possible hypertension (HT), and detection rates. METHODS: This observational study was based on the intervention arm of a screening trial in 25 083 Danish men aged 65-74 years. A combined screening programme for AAA, PAD and HT was offered at local hospitals. Participants with positive test results were offered secondary prophylaxis and/or referred to their general practitioner. The programme set-up included decentralized screening by three mobile teams at 14 venues. Diagnostic criteria were: aortic diameter at least 30 mm for AAA, ankle : brachial pressure index below 0.9 or above 1.4 for PAD, and BP exceeding 160/100 mmHg for HT. RESULTS: Overall, 18 749 men (uptake 74.7 per cent) attended the screening. An AAA was diagnosed in 3.3 (95 per cent c.i. 3.0 to 3.6) per cent, PAD in 10.9 (10.5 to 11.4) per cent and HT in 10.5 (10.0 to 10.9) per cent. Lipid-lowering and/or antiplatelet treatment was initiated in 34.8 per cent of the participants. CONCLUSION: Preventive actions were started in one-third of the attenders. The long-term effect of this on morbidity and mortality is an important part of future analysis. The trial confirms that the prevalence of AAA in Denmark has decreased only slightly in the past decade, from 4.0 to 3.3 per cent, in contrast to other nations.", "author" : [ { "dropping-particle" : "", "family" : "Grondal", "given" : "N", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Sogaard", "given" : "R", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Lindholt", "given" : "J S", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Br J Surg", "id" : "ITEM-2", "issue" : "8", "issued" : { "date-parts" : [ [ "2015" ] ] }, "note" : "Grondal, N\nSogaard, R\nLindholt, J S\neng\nObservational Study\nResearch Support, Non-U.S. Gov't\nEngland\n2015/04/30 06:00\nBr J Surg. 2015 Jul;102(8):902-6. doi: 10.1002/bjs.9825. Epub 2015 Apr 28.", "page" : "902-906", "title" : "Baseline prevalence of abdominal aortic aneurysm, peripheral arterial disease and hypertension in men aged 65-74 years from a population screening study (VIVA trial)", "type" : "article-journal", "volume" : "102" }, "uris" : [ "http://www.mendeley.com/documents/?uuid=9a782558-3a4d-490e-a1a1-9ee72f713379" ] } ], "mendeley" : { "formattedCitation" : "7,9", "plainTextFormattedCitation" : "7,9", "previouslyFormattedCitation" : "7,9" }, "properties" : { }, "schema" : "https://github.com/citation-style-language/schema/raw/master/csl-citation.json" }7,9 In Denmark, however, the AAA prevalence is no t a s l o w , 2 . 6 % i n 6 5 "y e a r o l d m e n a n d 0 . 9 % i n 7 1 "y e a r o l d w o m e n . A D D I N C S L _ C I T A T I O N { " c i t a t i o n I t e m s " : [ { " i d " : " I T E M - 1 " , " i t e m D a t a " : { " D O I " : " 1 0 . 1 1 8 6 / s 1 2 8 7 2 - 0 1 8 - 0 7 5 8 - 8 " , " I S B N " : " 1 4 7 1 - 2 2 6 1 ( E l e c t r o n i c ) \ r 1 4 7 1 - 2 2 6 1 ( L i n k i n g ) " , " P M I D " : " 2 9 4 0 2 2 3 3 " , " a bstract" : "BACKGROUND: Reducing women's cardiovascular risk and the economic costs associated with cardiovascular diseases (CVD) and diabetes (DM) continues to be a challenge. Whether a multifaceted CVD screening programme is beneficial as a preventive strategy in women remains uncertain. The aim of this study was to investigate the prevalence of CVD and DM as well as the acceptability toward screening and preventive actions. METHODS: An observational study was performed among all women born in 1936, 1941, 1946 and 1951 living in Viborg Municipality, Denmark, from October 2011. In total, 1984 were invited to screening for abdominal aortic aneurysm (AAA), peripheral arterial disease (PAD), carotid plaque (CP), hypertension (HT), atrial fibrillation (AF), DM and dyslipidaemia. Participants with positive tests were offered prophylactic intervention including follow-up consultations in case of AAA, PAD and/or CP. Participants with AAA >/= 50 mm were referred to specialists in vascular surgery. Women with AF or potential familial hypercholesterolaemia (FH) were referred to cardiology work-up. RESULTS: Among those invited, 1474 (74.3%) attended screening, but the attendees' share decreased with increasing age groups (p < 0.001). AAA was diagnosed in 10 (0.7%) women, PAD in 101 (6.9%) and CP in 602 (40.8%). The percentage of women with these conditions rose with increasing age group (p < 0.05). Unconfirmed potential HT was observed in 94 (6.4%), unknown AF in 6 (0.4%), DM in 14 (1%) and potential FH in 35 (2.4%). None of these findings differed across age groups. Among the 631 women diagnosed with AAA, PAD and/or CP, 182 (28.8%) were already in antiplatelet and 223 (35.3%) in lipid-lowering therapy prior to screening. Antiplatelet therapy was initiated in 215 (34.1%) and lipid-lowering therapy in 191 (30.3%) women. Initiation of antiplatelet and lipid-lowering therapy was further recommended to 134 (21.2%) and 141 (22.4%) women, respectively, who hesitated to follow the recommendation. CONCLUSIONS: The study recorded an acceptable total attendance rate, even though a significantly lower attendance rate was observed in the eldest women. The identified hesitation towards prophylactic therapy may affect the rationale and effectiveness of CVD screening, and hesitation seems a critical issue that should be addressed in the design of future screening programmes.", "author" : [ { "dropping-particle" : "", "family" : "Dahl", "given" : "M", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Frost", "given" : "L", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Sogaard", "given" : "R", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Klausen", "given" : "I C", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Lorentzen", "given" : "V", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Lindholt", "given" : "J", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "BMC Cardiovasc Disord", "id" : "ITEM-1", "issue" : "1", "issued" : { "date-parts" : [ [ "2018" ] ] }, "note" : "Dahl, Marie\nFrost, Lars\nSogaard, Rikke\nKlausen, Ib Christian\nLorentzen, Vibeke\nLindholt, Jes\neng\nResearch Support, Non-U.S. Gov't\nEngland\n2018/02/07 06:00\nBMC Cardiovasc Disord. 2018 Feb 5;18(1):20. doi: 10.1186/s12872-018-0758-8.", "page" : "20", "title" : "A population-based screening study for cardiovascular diseases and diabetes in Danish postmenopausal women: acceptability and prevalence", "type" : "article-journal", "volume" : "18" }, "uris" : [ "http://www.mendeley.com/documents/?uuid=8e0825ea-243e-426d-affe-fc348cb2e61a" ] } ], "mendeley" : { "formattedCitation" : "10", "plainTextFormattedCitation" : "10", "previouslyFormattedCitation" : "10" }, "properties" : { }, "schema" : "https://github.co m / c i t a t i o n - s t y l e - l a n g u a g e / s c h e m a / r a w / m a s t e r / c s l - c i t a t i o n . j s o n " } 1 0 A A A - r e l a t e d d e a t h h a s b e e n t h e 1 2 "1 5 t h l e a d i n g c a u s e o f d e a t h i n t h e U S A , U K a n d s e v e r a l E u r o p e a n c o u n t r i e s . T h e r e h a s b e e n d e c l i n e i n t h e n u m b e r o f m a l e s m o k e r s , w h i c h c o u l d c o n t r i b u t e to the decline in the AAA prevalence.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "ISBN" : "0741-5214 (Print)\r0741-5214 (Linking)", "PMID" : "12891116", "abstract" : "OBJECTIVE: Aortic aneurysm has traditionally been considered a manifestation of atherosclerosis, but recent evidence suggests an independent pathogenesis, possibly similar to that of chronic obstructive pulmonary disease (COPD). Further insight into the pathogenesis of aortic aneurysm might be obtained by comparing its association with smoking with that of other smoking-related diseases. STUDY DESIGN: We conducted a systematic review of studies providing relative risk associated with smoking for both aortic aneurysm and other smoking-related diseases. RESULTS: We identified 10 eligible studies, which included more than 3 million subjects. The events reported in 9 studies were death from target diseases; the tenth study reported new diagnoses. Relative risk for aortic aneurysm-related events in current smokers was generally 3 to 6, compared with 1 to 2 for coronary artery disease or cerebrovascular disease and 5 to 12 for COPD. For each category of smoking in each study, relative risk associated with smoking was substantially greater for aortic aneurysm than for coronary artery disease or cerebrovascular disease. Our pooled estimates indicate that, in men, the association of ever smoking with aortic aneurysm is 2.5 times greater than the association of ever smoking with coronary artery disease (95% confidence interval [CI], 2.2, 2.8) and 3.5 times greater than the association of ever smoking with cerebrovascular disease (95% CI, 2.4, 5.3), but only 0.56 as great as the association of ever smoking with COPD (95% CI, 0.36, 0.86). CONCLUSIONS: The difference in magnitude of these associations with smoking is consistent with a non-atherosclerotic cause for aortic aneurysm and/or a stronger effect of smoking on vascular disease in the peripheral arteries.", "author" : [ { "dropping-particle" : "", "family" : "Lederle", "given" : "F A", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Nelson", "given" : "D B", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Joseph", "given" : "A M", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "J Vasc Surg", "id" : "ITEM-1", "issue" : "2", "issued" : { "date-parts" : [ [ "2003" ] ] }, "note" : "Lederle, Frank A\nNelson, David B\nJoseph, Anne M\neng\nResearch Support, U.S. Gov't, Non-P.H.S.\nReview\n2003/08/02 05:00\nJ Vasc Surg. 2003 Aug;38(2):329-34.", "page" : "329-334", "title" : "Smokers' relative risk for aortic aneurysm compared with other smoking-related diseases: a systematic review", "type" : "article-journal", "volume" : "38" }, "uris" : [ "http://www.mendeley.com/documents/?uuid=71972392-c623-461f-bd1b-125d811b74f9" ] } ], "mendeley" : { "formattedCitation" : "11", "plainTextFormattedCitation" : "11", "previouslyFormattedCitation" : "11" }, "properties" : { }, "schema" : "https://github.com/citation-style-language/schema/raw/master/csl-citation.json" }11
The mortality in patients with AAA is high, both in treated and untreated patient groups, when compared to the general population, mainly due to the high occurrence of other atherosclerotic diseases and comorbidities.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1002/bjs.10715", "ISBN" : "1365-2168 (Electronic)\r0007-1323 (Linking)", "PMID" : "29265406", "abstract" : "BACKGROUND: This study aimed to assess how the prevalence and growth rates of small and medium abdominal aortic aneurysms (AAAs) (3.0-5.4 cm) have changed over time in men aged 65 years, and to evaluate long-term outcomes in men whose aortic diameter is 2.6-2.9 cm (subaneurysmal), and below the standard threshold for most surveillance programmes. METHODS: The Gloucestershire Aneurysm Screening Programme (GASP) started in 1990. Men aged 65 years with an aortic diameter of 2.6-5.4 cm, measured by ultrasonography using the inner to inner wall method, were included in surveillance. Aortic diameter growth rates were estimated separately for men who initially had a subaneurysmal aorta, and those who had a small or medium AAA, using mixed-effects models. RESULTS: Since 1990, 81 150 men had ultrasound screening for AAA (uptake 80.7 per cent), of whom 2795 had an aortic diameter of 2.6-5.4 cm. The prevalence of screen-detected AAA of 3.0 cm or larger decreased from 5.0 per cent in 1991 to 1.3 per cent in 2015. There was no evidence of a change in AAA growth rates during this time. Of men who initially had a subaneurysmal aorta, 57.6 (95 per cent c.i. 54.4 to 60.7) per cent were estimated to develop an AAA of 3.0 cm or larger within 5 years of the initial scan, and 28.0 (24.2 to 31.8) per cent to develop a large AAA (at least 5.5 cm) within 15 years. CONCLUSION: The prevalence of screen-detected small and medium AAAs has decreased over the past 25 years, but growth rates have remained similar. Men with a subaneurysmal aorta at age 65 years have a substantial risk of developing a large AAA by the age of 80 years.", "author" : [ { "dropping-particle" : "", "family" : "Oliver-Williams", "given" : "C", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Sweeting", "given" : "M J", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Turton", "given" : "G", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Parkin", "given" : "D", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Cooper", "given" : "D", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Rodd", "given" : "C", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Thompson", "given" : "S G", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Earnshaw", "given" : "J J", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Gloucestershire", "given" : "", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Swindon Abdominal Aortic Aneurysm Screening", "given" : "Programme", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Br J Surg", "id" : "ITEM-1", "issue" : "1", "issued" : { "date-parts" : [ [ "2018" ] ] }, "note" : "Oliver-Williams, C\nSweeting, M J\nTurton, G\nParkin, D\nCooper, D\nRodd, C\nThompson, S G\nEarnshaw, J J\neng\nEngland\n2017/12/22 06:00\nBr J Surg. 2018 Jan;105(1):68-74. doi: 10.1002/bjs.10715.", "page" : "68-74", "title" : "Lessons learned about prevalence and growth rates of abdominal aortic aneurysms from a 25-year ultrasound population screening programme", "type" : "article-journal", "volume" : "105" }, "uris" : [ "http://www.mendeley.com/documents/?uuid=67612048-6c73-43f5-896a-6a7221a7aaba" ] }, { "id" : "ITEM-2", "itemData" : { "DOI" : "10.1016/j.jvs.2010.05.090", "ISBN" : "1097-6809 (Electronic)\r0741-5214 (Linking)", "PMID" : "20630687", "abstract" : "BACKGROUND: Abdominal aortic aneurysm (AAA) disease is an insidious condition with an 85% chance of death after rupture. Ultrasound screening can reduce mortality, but its use is advocated only for a limited subset of the population at risk. METHODS: We used data from a retrospective cohort of 3.1 million patients who completed a medical and lifestyle questionnaire and were evaluated by ultrasound imaging for the presence of AAA by Life Line Screening in 2003 to 2008. Risk factors associated with AAA were identified using multivariable logistic regression analysis. RESULTS: We observed a positive association with increasing years of smoking and cigarettes smoked and a negative association with smoking cessation. Excess weight was associated with increased risk, whereas exercise and consumption of nuts, vegetables, and fruits were associated with reduced risk. Blacks, Hispanics, and Asians had lower risk of AAA than whites and Native Americans. Well-known risk factors were reaffirmed, including male gender, age, family history, and cardiovascular disease. A predictive scoring system was created that identifies aneurysms more efficiently than current criteria and includes women, nonsmokers, and individuals aged <65 years. Using this model on national statistics of risk factors prevalence, we estimated 1.1 million AAAs in the United States, of which 569,000 are among women, nonsmokers, and individuals aged <65 years. CONCLUSIONS: Smoking cessation and a healthy lifestyle are associated with lower risk of AAA. We estimated that about half of the patients with AAA disease are not eligible for screening under current guidelines. We have created a high-yield screening algorithm that expands the target population for screening by including at-risk individuals not identified with existing screening criteria.", "author" : [ { "dropping-particle" : "", "family" : "Kent", "given" : "K C", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Zwolak", "given" : "R M", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Egorova", "given" : "N N", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Riles", "given" : "T S", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Manganaro", "given" : "A", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Moskowitz", "given" : "A J", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Gelijns", "given" : "A C", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Greco", "given" : "G", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "J Vasc Surg", "id" : "ITEM-2", "issue" : "3", "issued" : { "date-parts" : [ [ "2010" ] ] }, "note" : "Kent, K Craig\nZwolak, Robert M\nEgorova, Natalia N\nRiles, Thomas S\nManganaro, Andrew\nMoskowitz, Alan J\nGelijns, Annetine C\nGreco, Giampaolo\neng\nResearch Support, Non-U.S. Gov't\n2010/07/16 06:00\nJ Vasc Surg. 2010 Sep;52(3):539-48. doi: 10.1016/j.jvs.2010.05.090. Epub 2010 Jul 13.", "page" : "539-548", "title" : "Analysis of risk factors for abdominal aortic aneurysm in a cohort of more than 3 million individuals", "type" : "article-journal", "volume" : "52" }, "uris" : [ "http://www.mendeley.com/documents/?uuid=3ea5c140-d672-4d47-8383-af34c87509ff" ] }, { "id" : "ITEM-3", "itemData" : { "DOI" : "10.1016/j.ejvs.2006.11.030", "ISBN" : "1078-5884 (Print)\r1078-5884 (Linking)", "PMID" : "17239633", "abstract" : "OBJECTIVE: The overall aim with this study was to investigate causes of death and mortality rates for women and men treated for abdominal aortic aneurysm (AAA) in Sweden. MATERIALS AND METHOD: All patients treated for ruptured and non-ruptured AAA 1987-2002 in Sweden were identified in national registries (n=12917). Age, sex, diagnosis, surgical procedure and mortality were analysed on a patient specific level. Logistic regression and analysis of standardised mortality rates (SMR) were performed. RESULTS: Post operative mortality was similar between the sexes. Age (p<0.0001), and surgery for rupture (p=0.0005), but not gender (p=0.65) were significant risk factor for poor long term survival. SMR revealed increased risk for both sexes compared to the population with significantly higher values for women than men (2.26, CI 2.10-2.43 vs. 1.63, CI 1.57-1.68, p<0.0001). The higher risk for women could be explained by the higher risk for aneurysm related death (ie.thoracic or abdominal aorta) compared to men (Hazard ratio 1.57 vs. 1.0, p<0.0001). CONCLUSION: Women do not have an increased surgical risk compared to men, but treated women have an increased risk of premature death compared to men and women in the population. They also have a higher risk for aneurysm related death compared to men with AAA.", "author" : [ { "dropping-particle" : "", "family" : "Hultgren", "given" : "R", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Granath", "given" : "F", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Swedenborg", "given" : "J", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Eur J Vasc Endovasc Surg", "id" : "ITEM-3", "issue" : "5", "issued" : { "date-parts" : [ [ "2007" ] ] }, "note" : "Hultgren, R\nGranath, F\nSwedenborg, J\neng\nResearch Support, Non-U.S. Gov't\nEngland\n2007/01/24 09:00\nEur J Vasc Endovasc Surg. 2007 May;33(5):556-60. doi: 10.1016/j.ejvs.2006.11.030. Epub 2007 Jan 17.", "page" : "556-560", "title" : "Different disease profiles for women and men with abdominal aortic aneurysms", "type" : "article-journal", "volume" : "33" }, "uris" : [ "http://www.mendeley.com/documents/?uuid=364ec2d4-97cc-4b5c-816b-12a034fa1ae5" ] }, { "id" : "ITEM-4", "itemData" : { "ISBN" : "0959-8138 (Print)\r0959-535X (Linking)", "PMID" : "9748177", "abstract" : "OBJECTIVE: To determine the long term relative survival of all patients who had surgery for abdominal aortic aneurysm in Western Australia during 1985-94. DESIGN: Population based study. SETTING: Western Australia. SUBJECTS: All patients who had had surgery for abdominal aortic aneurysm in Western Australia during 1985-94. MAIN OUTCOME MEASURES: Morbidity and mortality data of patients admitted and surgically treated for abdominal aortic aneurysm in Western Australia during 1985-94. Elective, ruptured, and acute non-ruptured cases were analysed separately. Independent analyses for sex and patients aged 80 years or more were also undertaken. Postoperative (>30 days) relative survival was assessed against age and sex matched controls. RESULTS: Overall, 1475 (1257 men, 218 women) cases were identified. The crude five year survival after elective surgery, including deaths within 30 days of surgery, was 79% for both men and women. When compared with a matched population the five year relative survival after elective surgery was 94.9% (95% confidence interval 89.9% to 99.9%) for men but only 88.0% (76.3% to 99.7%) for women. The five year relative survival of those aged 80 years and over was good: 116.6% (89.1% to 144.0%) compared with 92.4% (87.7% to 97.0%) for those under 80 years of age (men and women combined). Cardiovascular disease caused 57.8% of the 341 deaths after 30 days. CONCLUSION: In a condition such as abdominal aortic aneurysm, which occurs in elderly patients, relative survival is more clinically meaningful than crude survival. The five year relative survival in cases of elective and ruptured abdominal aortic aneurysm was better in men than in women. This is probably because of greater comorbidity in women with abdominal aortic aneurysm and this deserves more attention in the future. The long term survival outcome in octogenarians supports surgery in selected cases.", "author" : [ { "dropping-particle" : "", "family" : "Norman", "given" : "P E", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Semmens", "given" : "J B", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Lawrence-Brown", "given" : "M M", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Holman", "given" : "C D", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "BMJ", "id" : "ITEM-4", "issue" : "7162", "issued" : { "date-parts" : [ [ "1998" ] ] }, "note" : "Norman, P E\nSemmens, J B\nLawrence-Brown, M M\nHolman, C D\neng\nResearch Support, Non-U.S. Gov't\nEngland\nClinical research ed.\n1998/09/25 00:00\nBMJ. 1998 Sep 26;317(7162):852-6.", "page" : "852-856", "title" : "Long term relative survival after surgery for abdominal aortic aneurysm in western Australia: population based study", "type" : "article-journal", "volume" : "317" }, "uris" : [ "http://www.mendeley.com/documents/?uuid=42a7df83-2e2d-4c23-b7cc-42e0b6228bab" ] } ], "mendeley" : { "formattedCitation" : "8,12,49,50", "plainTextFormattedCitation" : "8,12,49,50", "previouslyFormattedCitation" : "8,12,49,50" }, "properties" : { }, "schema" : "https://github.com/citation-style-language/schema/raw/master/csl-citation.json" }8,12,49,50 The true incidence of ruptured AAA deaths outside health care institutions is difficult to determine given the decline in autopsy rates, but 50% of patients with ruptured AAA have been reported to die at home.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1067/mva.1993.42107", "ISBN" : "0741-5214 (Print)\r0741-5214 (Linking)", "PMID" : "8326662", "abstract" : "PURPOSE: The purpose of this study was to make an analysis of all ruptured abdominal aortic aneurysms in a defined population. METHODS: An epidemiologic analysis of ruptured abdominal aortic aneurysms (AAAs) was made in an urban population during a 16-year period. The study was retrospective and covered a demographically defined population of 230,000 inhabitants in the city of Malmo, Sweden. Reports of all identified ruptured AAAs in Malmo from 1971 to 1986 were analyzed. The autopsy rate in the city was 85% during this period. RESULTS: Ruptured AAAs were found in 5.6 of 100,000 persons (8.4/100,000 men and 3.0/100,000 women). No increase was found during the study period after age and sex standardization. The age-specific incidence was highest (113/100,000) in men 81 to 90 years old and (68/100,000) in women older than 90. The number of surgical interventions increased among men but not among women and the surgical mortality rate decreased from 86% to 43%. The overall mortality rate for ruptured AAA was 88%. The most common symptoms were abdominal pain and loss of consciousness. CONCLUSIONS: The validity of the study was based on a high autopsy rate. The incidence of aneurysm rupture was not low compared with other Scandinavian studies, but was low in comparison with studies from the United Kingdom. No increase in standardized rupture incidence was found. To substantially decrease the total mortality caused by rupture, operation must be performed before rupture.", "author" : [ { "dropping-particle" : "", "family" : "Bengtsson", "given" : "H", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Bergqvist", "given" : "D", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "J Vasc Surg", "id" : "ITEM-1", "issue" : "1", "issued" : { "date-parts" : [ [ "1993" ] ] }, "note" : "Bengtsson, H\nBergqvist, D\neng\nResearch Support, Non-U.S. Gov't\n1993/07/01 00:00\nJ Vasc Surg. 1993 Jul;18(1):74-80. doi: 10.1067/mva.1993.42107.", "page" : "74-80", "title" : "Ruptured abdominal aortic aneurysm: a population-based study", "type" : "article-journal", "volume" : "18" }, "uris" : [ "http://www.mendeley.com/documents/?uuid=5b8c5f95-1f99-4396-8251-189d8852482d" ] } ], "mendeley" : { "formattedCitation" : "59", "plainTextFormattedCitation" : "59", "previouslyFormattedCitation" : "59" }, "properties" : { }, "schema" : "https://github.com/citation-style-language/schema/raw/master/csl-citation.json" }59
Even though women are under-represented in most AAA studies, their outcomes are often reported to be worse than those in men, including higher rupture risk of small aneurysms and more complicated aneurysm morphology, which makes them more difficult to treat with standard surgical care.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1016/j.maturitas.2017.12.012", "ISBN" : "1873-4111 (Electronic)\r0378-5122 (Linking)", "PMID" : "29452784", "abstract" : "OBJECTIVE: Abdominal aortic aneurysm (AAA) predominantly affects an elderly male population. Even so, AAA appears more detrimental in women, who experience a higher risk of aneurysm rupture and a worse outcome after surgery than men. Why women are privileged from yet are worse off once affected has been attributed to an effect of sex hormones. This review summarizes the knowledge of sex differences in AAA and addresses the changes in the aneurysm wall from a gender perspective. METHOD: Standard reporting guidelines set by the PRISMA Group were followed to identify studies examining AAA from a gender perspective. Relevant reports were identified using two electronic databases: PubMed and Web of Science. The systematic search was performed in two stages: firstly, using the terms AAA and gender/sex/women; and secondly, adding the terms \"elastin\", \"collagen\" and \"vascular smooth muscle cells\", in order to filter the search for studies relevant to our focus on the aneurysm wall. CONCLUSION: Current studies support the theory that sex has an effect on aneurysm formation, yet are inconclusive about whether or not aneurysm formation is dependent on female/male sex hormones or a lack thereof. The studies in women are scarce and out of those most reports primarily address other end-points, which limit their ability to illuminate an effect of sex on aneurysm formation. The complexity of the human menstrual cycle and menopausal transition are difficult to mimic in animal models, which limit their applicability to AAA formation in humans.", "author" : [ { "dropping-particle" : "", "family" : "Villard", "given" : "C", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Hultgren", "given" : "R", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Maturitas", "id" : "ITEM-1", "issued" : { "date-parts" : [ [ "2018" ] ] }, "note" : "Villard, Christina\nHultgren, Rebecka\neng\nReview\nIreland\n2018/02/18 06:00\nMaturitas. 2018 Mar;109:63-69. doi: 10.1016/j.maturitas.2017.12.012. Epub 2017 Dec 13.", "page" : "63-69", "title" : "Abdominal aortic aneurysm: Sex differences", "type" : "article-journal", "volume" : "109" }, "uris" : [ "http://www.mendeley.com/documents/?uuid=b6e93bfa-89d3-4bd9-9b29-82005cbbae98" ] }, { "id" : "ITEM-2", "itemData" : { "DOI" : "10.1016/j.avsg.2012.05.025", "ISBN" : "1615-5947 (Electronic)\r0890-5096 (Linking)", "PMID" : "23522442", "abstract" : "BACKGROUND: The proportion of women with abdominal aortic aneurysm (AAA) treated with endovascular aortic repair (EVAR) is lower than for open repair (OR). Unfavorable morphologic features for EVAR in women with AAA may explain this disproportion. The objective of this study was to identify morphologic features in AAA patients undergoing elective repair with special emphasis on gender differences. METHODS: Patients undergoing elective repair from January 1, 2006 to December 31, 2008 at our university's vascular unit were included in this study. Computed tomography (CT) angiograms were analyzed. Morphologic features considered unfavorable for EVAR rather than open repair (OR) included: infrarenal aortic neck <15 mm; angulation >60 degrees ; circumferential neck thrombus; neck width >32 mm; iliac arteries <7.5 mm; or presence of bi-iliac aneurysms. Complex aortic neck was defined as a neck length of <15 mm and one or more of the other aortic neck exclusion criteria. RESULTS: One hundred seventy-two patients, including 140 men and 32 women, were treated during the study period, which included 99 with OR (21 women, 78 men) and 73 with EVAR (11 women, 62 men). Morphologic unsuitability for EVAR was 44% (75 of 172) and was not statistically different between women and men [47% (15 of 32) vs. 43% (60 of 140), P = 0.70]. Aortic neck pathology was the dominating feature for unsuitability for EVAR (69 of 75, 92%), and 85 of 172 patients had an unsuitable aortic neck. This rate was not different between women and men [19 of 32 (59%) vs. 66 of 140 (47%), P = 0.24]. Iliac unsuitability rates were 11% (19 of 172) and were not different between women and men [4 of 32 (12%) vs. 15 of 140 (11%), P = 0.76]. In patients unsuitable for EVAR, the proximal aortic necks showed more extensive aortic neck pathology in women than in men [8 of 15 (53%) vs. 13 of 60 (22%), P = 0.02]. More men had only short neck pathology [22 of 60 (37%) vs. 1 of 15 (7%), P = 0.03]. CONCLUSIONS: Aortic neck pathology is the dominating cause of EVAR exclusion in both genders. A higher proportion of women have more pathologic neck anatomy. Future development of EVAR devices should focus on the complexity of the aortic neck, which will benefit all AAA patients, but especially women.", "author" : [ { "dropping-particle" : "", "family" : "Hultgren", "given" : "R", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Vishnevskaya", "given" : "L", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Wahlgren", "given" : "C M", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Ann Vasc Surg", "id" : "ITEM-2", "issue" : "5", "issued" : { "date-parts" : [ [ "2013" ] ] }, "note" : "Hultgren, Rebecka\nVishnevskaya, Liya\nWahlgren, Carl Magnus\neng\nResearch Support, Non-U.S. Gov't\nNetherlands\n2013/03/26 06:00\nAnn Vasc Surg. 2013 Jul;27(5):547-52. doi: 10.1016/j.avsg.2012.05.025. Epub 2013 Mar 20.", "page" : "547-552", "title" : "Women with abdominal aortic aneurysms have more extensive aortic neck pathology", "type" : "article-journal", "volume" : "27" }, "uris" : [ "http://www.mendeley.com/documents/?uuid=a1fb77dc-5cf7-4a65-bf78-4b053e877b63" ] }, { "id" : "ITEM-3", "itemData" : { "DOI" : "10.1016/j.jvs.2016.10.074", "ISBN" : "1097-6809 (Electronic)\r0741-5214 (Linking)", "PMID" : "28342508", "abstract" : "OBJECTIVE: Finite element analysis (FEA) has been suggested to be superior to maximal diameter measurements in predicting rupture of abdominal aortic aneurysms (AAAs). Our objective was to investigate to what extent previously described rupture risk factors were associated with FEA-estimated rupture risk. METHODS: One hundred forty-six patients with an asymptomatic AAA of a 40- to 60-mm diameter were retrospectively identified and consecutively included. The patients' computed tomography angiograms were analyzed by FEA without (neutral) and with (specific) input of patient-specific mean arterial pressure (MAP), gender, family history, and age. The maximal wall stress/wall strength ratio was described as a rupture risk equivalent diameter (RRED), which translated this ratio into an average aneurysm diameter of corresponding rupture risk. RESULTS: In multivariate linear regression, RREDneutral increased with female gender (3.7 mm; 95% confidence interval [CI], 0.13-7.3) and correlated with patient height (0.27 mm/cm; 95% CI, 0.11-0.43) and body surface area (BSA, 16 mm/m(2); 95% CI, 8.3-24) and inversely with body mass index (BMI, -0.40 mm/kg m(-2); 95% CI, -0.75 to -0.054) in a wall stress-dependent manner. Wall stress-adjusted RREDneutral was raised if the patient was currently smoking (1.1 mm; 95% CI, 0.21-1.9). Age, MAP, family history, and patient weight were unrelated to RREDneutral. In specific FEA, RREDspecific increased with female gender, MAP, family history positive for AAA, height, and BSA, whereas it was inversely related to BMI. All results were independent of aneurysm diameter. Peak wall stress and RRED correlated with aneurysm diameter and lumen volume. CONCLUSIONS: Female gender, current smoking, increased patient height and BSA, and low BMI were found to increase the mechanical rupture risk of AAAs. Previously described rupture risk factors may in part be explained by patient characteristic-dependent variations in aneurysm biomechanics.", "author" : [ { "dropping-particle" : "", "family" : "Lindquist Liljeqvist", "given" : "M", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Hultgren", "given" : "R", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Siika", "given" : "A", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Gasser", "given" : "T C", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Roy", "given" : "J", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "J Vasc Surg", "id" : "ITEM-3", "issue" : "4", "issued" : { "date-parts" : [ [ "2017" ] ] }, "note" : "Lindquist Liljeqvist, Moritz\nHultgren, Rebecka\nSiika, Antti\nGasser, T Christian\nRoy, Joy\neng\n2017/03/28 06:00\nJ Vasc Surg. 2017 Apr;65(4):1014-1021.e4. doi: 10.1016/j.jvs.2016.10.074.", "page" : "1014-1021 e4", "title" : "Gender, smoking, body size, and aneurysm geometry influence the biomechanical rupture risk of abdominal aortic aneurysms as estimated by finite element analysis", "type" : "article-journal", "volume" : "65" }, "uris" : [ "http://www.mendeley.com/documents/?uuid=53d90a21-aa21-435a-a962-6a09127b1ac4" ] }, { "id" : "ITEM-4", "itemData" : { "DOI" : "10.1016/S0140-6736(17)30639-6", "ISBN" : "1474-547X (Electronic)\r0140-6736 (Linking)", "PMID" : "28455148", "abstract" : "BACKGROUND: Prognosis for women with abdominal aortic aneurysm might be worse than the prognosis for men. We aimed to systematically quantify the differences in outcomes between men and women being assessed for repair of intact abdominal aortic aneurysm using data from study periods after the year 2000. METHODS: In these systematic reviews and meta-analysis, we identified studies (randomised, cohort, or cross-sectional) by searching MEDLINE, Embase, CENTRAL, and grey literature published between Jan 1, 2005, and Sept 2, 2016, for two systematic reviews and Jan 1, 2009, and Sept 2, 2016, for one systematic review. Studies were included if they were of both men and women, with data presented for each sex separately, with abdominal aortic aneurysms being assessed for aneurysm repair by either endovascular repair (EVAR) or open repair. We conducted three reviews based on whether studies reported the proportion morphologically suitable (within manufacturers' instructions for use) for EVAR (EVAR suitability review), non-intervention rates (non-intervention review), and 30-day mortality (operative mortality review) after intact aneurysm repair. Studies had to include at least 20 women (for the EVAR suitability review), 20 women (for the non-intervention review), and 50 women (for the operative mortality review). Studies were excluded if they were review articles, editorials, letters, or case reports. For the operative review, studies were also excluded if they only provided hazard ratios or only reported in-hospital mortality. We assessed the quality of the studies using the Newcastle-Ottawa scoring system, and contacted authors for the provision of additional data if needed. We combined results across studies by random-effects meta-analysis. This study is registered with PROSPERO, number CRD42016043227. FINDINGS: Five studies assessed the morphological eligibility for EVAR (1507 men, 400 women). The overall pooled proportion of women eligible (34%) for EVAR was lower than it was in men (54%; odds ratio [OR] 0.44, 95% CI 0.32-0.62). Four single-centre studies reported non-intervention rates (1365 men, 247 women). The overall pooled non-intervention rates were higher in women (34%) than men (19%; OR 2.27, 95% CI 1.21-4.23). The review of 30-day mortality included nine studies (52 018 men, 11 076 women). The overall pooled estimate for EVAR was higher in women (2.3%) than in men (1.4%; OR 1.67, 95% CI 1.38-2.04). The overall estimate for open repair also was hig\u2026", "author" : [ { "dropping-particle" : "", "family" : "Ulug", "given" : "P", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Sweeting", "given" : "M J", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Allmen", "given" : "R S", "non-dropping-particle" : "von", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Thompson", "given" : "S G", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Powell", "given" : "J T", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "collaborators", "given" : "Swan", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Lancet", "id" : "ITEM-4", "issue" : "10088", "issued" : { "date-parts" : [ [ "2017" ] ] }, "note" : "Ulug, Pinar\nSweeting, Michael J\nvon Allmen, Regula S\nThompson, Simon G\nPowell, Janet T\neng\nEngland\nLondon, England\n2017/04/30 06:00\nLancet. 2017 Jun 24;389(10088):2482-2491. doi: 10.1016/S0140-6736(17)30639-6. Epub 2017 Apr 25.", "page" : "2482-2491", "title" : "Morphological suitability for endovascular repair, non-intervention rates, and operative mortality in women and men assessed for intact abdominal aortic aneurysm repair: systematic reviews with meta-analysis", "type" : "article-journal", "volume" : "389" }, "uris" : [ "http://www.mendeley.com/documents/?uuid=e8dd9a70-7375-4b41-b0d8-c7ccb66c4806" ] }, { "id" : "ITEM-5", "itemData" : { "author" : [ { "dropping-particle" : "", "family" : "Nischan", "given" : "J", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Lenk", "given" : "G M", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Boddy", "given" : "A M", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Lillvis", "given" : "J H", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Tromp", "given" : "G", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Kuivaniemi", "given" : "H", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Aneurysms: Types, Risks, Formation and Treatment", "edition" : "Nova Biome", "editor" : [ { "dropping-particle" : "", "family" : "Laurent", "given" : "A", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Morel", "given" : "E", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "id" : "ITEM-5", "issued" : { "date-parts" : [ [ "2009" ] ] }, "page" : "35-93", "title" : "Abdominal Aortic Aneurysms-a Complex Genetic Disease", "type" : "chapter" }, "uris" : [ "http://www.mendeley.com/documents/?uuid=2c7b9806-ce60-4bbb-a249-b955780c3985" ] }, { "id" : "ITEM-6", "itemData" : { "ISBN" : "0003-4819 (Print)\r0003-4819 (Linking)", "PMID" : "9072929", "abstract" : "BACKGROUND: Independent risk factors for abdominal aortic aneurysm (AAA) have not been clearly defined in multivariable analyses of large patient populations. OBJECTIVE: To identify factors that are independently associated with AAA and to determine the prevalence of previously unrecognized AAA in defined demographic and risk groups. DESIGN: Cross-sectional screening study. SETTING: 15 Department of Veterans Affairs medical centers. PARTICIPANTS: 73451 veterans who were 50 to 79 years of age and had no history of AAA. MEASUREMENTS: The results of ultrasonographic screening for AAA and a prescreening questionnaire were analyzed using multiple logistic regression. RESULTS: An AAA of 4.0 cm or larger was detected in 1031 participants (1.4%). Smoking was the risk factor most strongly associated with AAA; the odds ratio (OR) for AAAs of 4.0 cm or larger compared with normal aortas (infrarenal aortic diameter < 3.0 cm) was 5.57 (95% CI, 4.24 to 7.31). The association between smoking and AAA increased significantly with the number of years of smoking and decreased significantly with the number of years after quitting smoking. The excess prevalence associated with smoking accounted for 78% of all AAAs that were 4.0 cm or larger in the study sample. Female sex (OR, 0.22 [CI, 0.07 to 0.68]), black race (OR, 0.49 [CI, 0.35 to 0.69]), and presence of diabetes (OR, 0.54 [CI, 0.44 to 0.65]) were negatively associated with AAA. A family history of AAA was positively associated with AAA (OR, 1.95 [CI, 1.56 to 2.43]) but was reported by only 5.1% of participants. Other independently associated factors included age, height, coronary artery disease, any atherosclerosis, high cholesterol levels, and hypertension. CONCLUSIONS: Abdominal aortic aneurysm is associated with multiple factors. Smoking was the risk factor most strongly associated with AAA and may be responsible for most clinically important cases of previously undiagnosed AAA.", "author" : [ { "dropping-particle" : "", "family" : "Lederle", "given" : "F A", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Johnson", "given" : "G R", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Wilson", "given" : "S E", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Chute", "given" : "E P", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Littooy", "given" : "F N", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Bandyk", "given" : "D", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Krupski", "given" : "W C", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Barone", "given" : "G W", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Acher", "given" : "C W", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Ballard", "given" : "D J", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Ann Intern Med", "edition" : "1997/03/15", "id" : "ITEM-6", "issue" : "6", "issued" : { "date-parts" : [ [ "1997" ] ] }, "language" : "eng", "note" : "Lederle, F A\nJohnson, G R\nWilson, S E\nChute, E P\nLittooy, F N\nBandyk, D\nKrupski, W C\nBarone, G W\nAcher, C W\nBallard, D J\nMulticenter Study\nResearch Support, U.S. Gov't, Non-P.H.S.\nUnited states\nAnnals of internal medicine\nAnn Intern Med. 1997 Mar 15;126(6):441-9.", "page" : "441-449", "title" : "Prevalence and associations of abdominal aortic aneurysm detected through screening. Aneurysm Detection and Management (ADAM) Veterans Affairs Cooperative Study Group", "type" : "article-journal", "volume" : "126" }, "uris" : [ "http://www.mendeley.com/documents/?uuid=e6c35270-7cae-47e8-85dc-1c69acf1e4a3" ] } ], "mendeley" : { "formattedCitation" : "22,23,55\u201358", "plainTextFormattedCitation" : "22,23,55\u201358", "previouslyFormattedCitation" : "22,23,55\u201358" }, "properties" : { }, "schema" : "https://github.com/citation-style-language/schema/raw/master/csl-citation.json" }22,23,5558
Women with AAA seem to have a worse prognosis compared to men. A recent meta-analysis comparing outcomes of AAA repair (EVAR and open repair) between men and women showed that 30-day mortality was higher in women compared to men both for EVAR (2.3% vs. 1.4%, OR 1.67, 95% CI 1.382.04) and open repair (5.4% vs. 2.8%; OR 1.76, 95% CI 1.352.30).ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1016/S0140-6736(17)30639-6", "ISBN" : "1474-547X (Electronic)\r0140-6736 (Linking)", "PMID" : "28455148", "abstract" : "BACKGROUND: Prognosis for women with abdominal aortic aneurysm might be worse than the prognosis for men. We aimed to systematically quantify the differences in outcomes between men and women being assessed for repair of intact abdominal aortic aneurysm using data from study periods after the year 2000. METHODS: In these systematic reviews and meta-analysis, we identified studies (randomised, cohort, or cross-sectional) by searching MEDLINE, Embase, CENTRAL, and grey literature published between Jan 1, 2005, and Sept 2, 2016, for two systematic reviews and Jan 1, 2009, and Sept 2, 2016, for one systematic review. Studies were included if they were of both men and women, with data presented for each sex separately, with abdominal aortic aneurysms being assessed for aneurysm repair by either endovascular repair (EVAR) or open repair. We conducted three reviews based on whether studies reported the proportion morphologically suitable (within manufacturers' instructions for use) for EVAR (EVAR suitability review), non-intervention rates (non-intervention review), and 30-day mortality (operative mortality review) after intact aneurysm repair. Studies had to include at least 20 women (for the EVAR suitability review), 20 women (for the non-intervention review), and 50 women (for the operative mortality review). Studies were excluded if they were review articles, editorials, letters, or case reports. For the operative review, studies were also excluded if they only provided hazard ratios or only reported in-hospital mortality. We assessed the quality of the studies using the Newcastle-Ottawa scoring system, and contacted authors for the provision of additional data if needed. We combined results across studies by random-effects meta-analysis. This study is registered with PROSPERO, number CRD42016043227. FINDINGS: Five studies assessed the morphological eligibility for EVAR (1507 men, 400 women). The overall pooled proportion of women eligible (34%) for EVAR was lower than it was in men (54%; odds ratio [OR] 0.44, 95% CI 0.32-0.62). Four single-centre studies reported non-intervention rates (1365 men, 247 women). The overall pooled non-intervention rates were higher in women (34%) than men (19%; OR 2.27, 95% CI 1.21-4.23). The review of 30-day mortality included nine studies (52 018 men, 11 076 women). The overall pooled estimate for EVAR was higher in women (2.3%) than in men (1.4%; OR 1.67, 95% CI 1.38-2.04). The overall estimate for open repair also was hig\u2026", "author" : [ { "dropping-particle" : "", "family" : "Ulug", "given" : "P", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Sweeting", "given" : "M J", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Allmen", "given" : "R S", "non-dropping-particle" : "von", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Thompson", "given" : "S G", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Powell", "given" : "J T", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "collaborators", "given" : "Swan", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Lancet", "id" : "ITEM-1", "issue" : "10088", "issued" : { "date-parts" : [ [ "2017" ] ] }, "note" : "Ulug, Pinar\nSweeting, Michael J\nvon Allmen, Regula S\nThompson, Simon G\nPowell, Janet T\neng\nEngland\nLondon, England\n2017/04/30 06:00\nLancet. 2017 Jun 24;389(10088):2482-2491. doi: 10.1016/S0140-6736(17)30639-6. Epub 2017 Apr 25.", "page" : "2482-2491", "title" : "Morphological suitability for endovascular repair, non-intervention rates, and operative mortality in women and men assessed for intact abdominal aortic aneurysm repair: systematic reviews with meta-analysis", "type" : "article-journal", "volume" : "389" }, "uris" : [ "http://www.mendeley.com/documents/?uuid=e8dd9a70-7375-4b41-b0d8-c7ccb66c4806" ] } ], "mendeley" : { "formattedCitation" : "56", "plainTextFormattedCitation" : "56", "previouslyFormattedCitation" : "56" }, "properties" : { }, "schema" : "https://github.com/citation-style-language/schema/raw/master/csl-citation.json" }56 Women were also less likely to be morphologically eligible to EVAR and were less frequently offered prophylactic repair compared to men. The authors suggested that a smaller threshold for intervention for women might potentially improve outcomes, given that women have smaller aortas compared to men.
Ethnic differences in outcomes following AAA repair have also been demonstrated, with specific ethnic groups having a worse short-term and mid-term prognosis compared to others. Khashram et al.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1016/j.ejvs.2017.08.018", "ISSN" : "1532-2165", "PMID" : "29029952", "abstract" : "OBJECTIVES Socio-economic status (SES) and ethnicity have been reported as markers influencing the likelihood of increased mortality. The aim of this study was to investigate how SES and ethnicity impacted patient survival after abdominal aortic aneurysm (AAA) repair. METHODS Consecutive patients undergoing open and endovascular AAA repair during a 14.5 year period were identified. Ethnicity was defined as recorded on health records and SES (a score of 10, where 1 is least deprived and 10 being most deprived) and was linked to census data. Operative outcomes were reported at 30 days and a medium-term survival analysis used the Cox model to report adjusted hazard ratios (HR). RESULTS A total of 6239 patients with a median age of 75 years and 78.7% males were included. The majority (5,654) were identified as New Zealand (NZ) Europeans, with 421 identified as NZ Maori, 97 identified as belonging to a Pacific ethnic group, and 67 identified as an Asian ethnic group. The median survival follow-up period was 5 years and after adjusting for confounders, those who identified as NZ Maori had the lowest survival compared with all other ethnic groups with a HR of 1.46 (95% CI 1.23-1.72). Living in areas of high social deprivation \u2265 7 was an independent predictor of short and medium-term overall mortality when compared with living in deprivation deciles 1 or 2. CONCLUSIONS Low SES was identified as a marker of risk for all ethnic groups in relation to both reduced short and medium-term survival. However, regardless of SES, NZ Maori had worse overall medium-term survival following AAA repair than the other ethnic groups. Therefore it appears that both SES and being Maori were markers of increased exposure to risk that negatively impact upon survival after AAA repair. There is a need to ensure systemic processes support initiatives that reduce this inequality.", "author" : [ { "dropping-particle" : "", "family" : "Khashram", "given" : "Manar", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Pitama", "given" : "Suzanne", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Williman", "given" : "Jonathan A", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Jones", "given" : "Gregory T", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Roake", "given" : "Justin A", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "European journal of vascular and endovascular surgery : the official journal of the European Society for Vascular Surgery", "id" : "ITEM-1", "issue" : "6", "issued" : { "date-parts" : [ [ "2017", "12" ] ] }, "page" : "689-696", "title" : "Survival Disparity Following Abdominal Aortic Aneurysm Repair Highlights Inequality in Ethnic and Socio-economic Status.", "type" : "article-journal", "volume" : "54" }, "uris" : [ "http://www.mendeley.com/documents/?uuid=ae52e032-d407-396d-aefc-ee175005d4d6" ] } ], "mendeley" : { "formattedCitation" : "176", "plainTextFormattedCitation" : "176", "previouslyFormattedCitation" : "176" }, "properties" : { }, "schema" : "https://github.com/citation-style-language/schema/raw/master/csl-citation.json" }176 showed that the Maori group in New Zealand had inferior mid-term survival after EVAR and open AAA repair compared to all other ethnic groups. Deery et al. analyzed data from the Vascular Quality Initiative (VQI) and demonstrated that black patients in the USA have a higher risk of developing postoperative renal failure and return to the operating room compared to white and Asian patients. Asian patients were more likely to suffer postoperative myocardial infarction.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1016/j.jvs.2017.07.138", "ISSN" : "07415214", "PMID" : "29074109", "abstract" : "OBJECTIVE We aimed to compare perioperative morbidity and mortality and late survival among black, white, and Asian patients undergoing intact abdominal aortic aneurysm (AAA) repair. METHODS We identified all patients undergoing intact, infrarenal AAA repair in the Vascular Quality Initiative (VQI) from 2003 to 2017. We compared in-hospital outcomes by race using the Fisher exact and Kruskal-Wallis tests. Multivariable logistic and linear regression models of perioperative outcomes adjusted for differences in demographics, comorbidities, hospital volume, and procedure. We used Cox regression to evaluate late survival by race. RESULTS In the cohort, 21,961 (94%) patients were white, 1215 (5.2%) were black, and 318 (1.4%) were Asian. Black patients were more likely to be symptomatic (black, 16%; white, 9.1%; Asian, 11%; P\u00a0< .001) and to undergo endovascular aneurysm repair (EVAR; black, 87%; white, 83%; Asian, 84%; P\u00a0< .001). There were no differences in 30-day mortality after EVAR (black, 1.1%; white, 1.1%; Asian, 0.8%; P\u00a0= .80) or open repair (black; 4.3%; white, 2.6%; Asian, 1.9%; P\u00a0= .33). However, black patients were more likely to receive new postoperative dialysis (black, 1.6%; white, 0.8%; Asian; 0.7%; P\u00a0= .01) and to return to the operating room (black, 4.3%; white, 2.9%; Asian, 0.9%; P\u00a0< .01). Mean hospital length of stay was longer in black patients after EVAR (black, 3.3\u00a0days; white, 2.6\u00a0days; Asian, 2.6\u00a0days; P\u00a0< .001) and in Asian and black patients after open repair (black, 10.5\u00a0days; white, 8.5\u00a0days; Asian, 13.0\u00a0days; P\u00a0< .001). After multivariable adjustment, black patients were more likely than white patients to have postoperative dialysis (odds ratio, 2.2; 95% confidence interval [CI], 1.3-3.6; P\u00a0< .01) and return to the operating room (odds ratio, 1.6; 95% CI, 1.2-2.2; P\u00a0< .01). Five-year survival was highest for Asian patients (black, 84%; white, 85%; Asian, 92%), even in the adjusted Cox model (Asian: hazard ratio, 0.6; 95% CI, 0.4-0.97; P\u00a0= .04). CONCLUSIONS Although perioperative mortality is comparable across races after AAA repair, black patients are more likely than white or Asian patients to develop new postoperative renal failure and return to the operating room, even after adjusting for differences in comorbidities, operative variables, and hospital volume. In addition, whereas Asian patients have the highest rate of postoperative myocardial infarction, they also have the highest late survival. Further studies are warranted t\u2026", "author" : [ { "dropping-particle" : "", "family" : "Deery", "given" : "Sarah E.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "O'Donnell", "given" : "Thomas F.X.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Shean", "given" : "Katie E.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Darling", "given" : "Jeremy D.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Soden", "given" : "Peter A.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Hughes", "given" : "Kakra", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Wang", "given" : "Grace J.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Schermerhorn", "given" : "Marc L.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Society for Vascular Surgery Vascular Quality Initiative", "given" : "", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Journal of Vascular Surgery", "id" : "ITEM-1", "issue" : "4", "issued" : { "date-parts" : [ [ "2018", "4" ] ] }, "page" : "1059-1067", "title" : "Racial disparities in outcomes after intact abdominal aortic aneurysm repair", "type" : "article-journal", "volume" : "67" }, "uris" : [ "http://www.mendeley.com/documents/?uuid=f4312cbb-5776-3d34-9cbf-d5fe77cdaf2d" ] } ], "mendeley" : { "formattedCitation" : "177", "plainTextFormattedCitation" : "177", "previouslyFormattedCitation" : "177" }, "properties" : { }, "schema" : "https://github.com/citation-style-language/schema/raw/master/csl-citation.json" }177Other studies have shown that Hispanics in the USA have higher perioperative mortality and morbidity rates following AAA repair compared to other ethnic groups.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1097/SLA.0000000000001078", "ISSN" : "1528-1140", "PMID" : "26501490", "abstract" : "OBJECTIVE To determine the association between race/ethnicity and perioperative outcomes in individuals undergoing major oncologic and nononcologic surgical procedures in the United States. BACKGROUND Prior work has shown that there are significant racial/ethnic disparities in perioperative outcomes after several types of major cardiac, general, vascular, orthopedic, and cancer surgical procedures. However, recent evidence suggests attenuation of these racial/ethnic differences, particularly at academic institutions. METHODS We utilized the American College of Surgeons National Surgical Quality Improvement Program database to identify 142,344 patients undergoing one of the 16 major cancer and noncancer surgical procedures between 2005 and 2011. RESULTS Eighty-five percent of the cohort was white, with black and Hispanic individuals comprising 8% and 4%, respectively. In multivariable analyses, black patients had greater odds of experiencing prolonged length of stay after 10 of the 16 procedures studied (all P\u200a<\u200a0.05), though there was no disparity in odds of 30-day mortality after any surgery. Hispanics were more likely to experience prolonged length of stay after 5 surgical procedures (all P\u200a<\u200a0.04), and were at greater odds of dying within 30 days after colectomy, heart valve repair/replacement, or abdominal aortic aneurysm repair (all P\u200a<\u200a0.03). Fewer disparities were observed for Hispanics, than for black patients, and also for cancer, than for noncancer surgical procedures. CONCLUSIONS Important racial/ethnic disparities in perioperative outcomes were observed among patients undergoing major cancer and noncancer surgical procedures at American College of Surgeons National Surgical Quality Improvement Program institutions. There were fewer disparities among individuals undergoing cancer surgery, though black patients, in particular, were more likely to experience prolonged length of stay.", "author" : [ { "dropping-particle" : "", "family" : "Ravi", "given" : "Praful", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Sood", "given" : "Akshay", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Schmid", "given" : "Marianne", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Abdollah", "given" : "Firas", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Sammon", "given" : "Jesse D", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Sun", "given" : "Maxine", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Klett", "given" : "Dane E", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Varda", "given" : "Briony", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Peabody", "given" : "James O", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Menon", "given" : "Mani", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Kibel", "given" : "Adam S", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Nguyen", "given" : "Paul L", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Trinh", "given" : "Quoc-Dien", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Annals of surgery", "id" : "ITEM-1", "issue" : "6", "issued" : { "date-parts" : [ [ "2015", "12" ] ] }, "page" : "955-64", "title" : "Racial/Ethnic Disparities in Perioperative Outcomes of Major Procedures: Results From the National Surgical Quality Improvement Program.", "type" : "article-journal", "volume" : "262" }, "uris" : [ "http://www.mendeley.com/documents/?uuid=e039cb7d-7759-3de5-9a97-b3ef6e57765c" ] }, { "id" : "ITEM-2", "itemData" : { "DOI" : "10.1016/j.avsg.2012.06.006", "ISSN" : "08905096", "author" : [ { "dropping-particle" : "", "family" : "Williams", "given" : "Timothy K.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Schneider", "given" : "Eric B.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Black", "given" : "James H.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Lum", "given" : "Ying Wei", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Freischlag", "given" : "Julie A.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Perler", "given" : "Bruce A.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Abularrage", "given" : "Christopher J.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Annals of Vascular Surgery", "id" : "ITEM-2", "issue" : "1", "issued" : { "date-parts" : [ [ "2013", "1" ] ] }, "page" : "29-37", "title" : "Disparities in Outcomes for Hispanic Patients Undergoing Endovascular and Open Abdominal Aortic Aneurysm Repair", "type" : "article-journal", "volume" : "27" }, "uris" : [ "http://www.mendeley.com/documents/?uuid=3ab9afe6-010c-3705-8adb-db587796f343" ] } ], "mendeley" : { "formattedCitation" : "178,179", "plainTextFormattedCitation" : "178,179", "previouslyFormattedCitation" : "178,179" }, "properties" : { }, "schema" : "https://github.com/citation-style-language/schema/raw/master/csl-citation.json" }178,179 Different factors have been suggested to explain these differences in outcomes between ethnicities. These include different access to high-quality centers (e.g. black patients being treated more often in lower volume centers), differences in anatomical extent of the AAA (e.g. black and Asian patients seem to have more often concomitant iliac artery aneurysms requiring more complex procedures) and differences in preoperative comorbidities.
[H2] Risk factors
The more common fusiform AAA, which is the focus of this article, is a complex, multifactorial late-age-at-onset disease with both genetic and environmental risk factors.
The infrarenal abdominal aorta is a common site for both atherosclerotic non-aneurysmatic aneurysmal occlusive disease and aneurysmal disease. Historically AAA was considered one manifestation of atherosclerosis. AAAs and occlusive atherothrombotic disease share several risk factors, including smoking, older age, a positive family history and male sex (FIG. 2).
Several risk groups can be found that have a high prevalence of AAA, such as patients with coronary heart disease, hyperlipidemia, hypertension and chronic obstructive pulmonary disease (COPD).ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "ISBN" : "0741-5214 (Print)\r0741-5214 (Linking)", "PMID" : "12891116", "abstract" : "OBJECTIVE: Aortic aneurysm has traditionally been considered a manifestation of atherosclerosis, but recent evidence suggests an independent pathogenesis, possibly similar to that of chronic obstructive pulmonary disease (COPD). Further insight into the pathogenesis of aortic aneurysm might be obtained by comparing its association with smoking with that of other smoking-related diseases. STUDY DESIGN: We conducted a systematic review of studies providing relative risk associated with smoking for both aortic aneurysm and other smoking-related diseases. RESULTS: We identified 10 eligible studies, which included more than 3 million subjects. The events reported in 9 studies were death from target diseases; the tenth study reported new diagnoses. Relative risk for aortic aneurysm-related events in current smokers was generally 3 to 6, compared with 1 to 2 for coronary artery disease or cerebrovascular disease and 5 to 12 for COPD. For each category of smoking in each study, relative risk associated with smoking was substantially greater for aortic aneurysm than for coronary artery disease or cerebrovascular disease. Our pooled estimates indicate that, in men, the association of ever smoking with aortic aneurysm is 2.5 times greater than the association of ever smoking with coronary artery disease (95% confidence interval [CI], 2.2, 2.8) and 3.5 times greater than the association of ever smoking with cerebrovascular disease (95% CI, 2.4, 5.3), but only 0.56 as great as the association of ever smoking with COPD (95% CI, 0.36, 0.86). CONCLUSIONS: The difference in magnitude of these associations with smoking is consistent with a non-atherosclerotic cause for aortic aneurysm and/or a stronger effect of smoking on vascular disease in the peripheral arteries.", "author" : [ { "dropping-particle" : "", "family" : "Lederle", "given" : "F A", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Nelson", "given" : "D B", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Joseph", "given" : "A M", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "J Vasc Surg", "id" : "ITEM-1", "issue" : "2", "issued" : { "date-parts" : [ [ "2003" ] ] }, "note" : "Lederle, Frank A\nNelson, David B\nJoseph, Anne M\neng\nResearch Support, U.S. Gov't, Non-P.H.S.\nReview\n2003/08/02 05:00\nJ Vasc Surg. 2003 Aug;38(2):329-34.", "page" : "329-334", "title" : "Smokers' relative risk for aortic aneurysm compared with other smoking-related diseases: a systematic review", "type" : "article-journal", "volume" : "38" }, "uris" : [ "http://www.mendeley.com/documents/?uuid=71972392-c623-461f-bd1b-125d811b74f9" ] }, { "id" : "ITEM-2", "itemData" : { "DOI" : "10.1016/j.jvs.2010.05.090", "ISBN" : "1097-6809 (Electronic)\r0741-5214 (Linking)", "PMID" : "20630687", "abstract" : "BACKGROUND: Abdominal aortic aneurysm (AAA) disease is an insidious condition with an 85% chance of death after rupture. Ultrasound screening can reduce mortality, but its use is advocated only for a limited subset of the population at risk. METHODS: We used data from a retrospective cohort of 3.1 million patients who completed a medical and lifestyle questionnaire and were evaluated by ultrasound imaging for the presence of AAA by Life Line Screening in 2003 to 2008. Risk factors associated with AAA were identified using multivariable logistic regression analysis. RESULTS: We observed a positive association with increasing years of smoking and cigarettes smoked and a negative association with smoking cessation. Excess weight was associated with increased risk, whereas exercise and consumption of nuts, vegetables, and fruits were associated with reduced risk. Blacks, Hispanics, and Asians had lower risk of AAA than whites and Native Americans. Well-known risk factors were reaffirmed, including male gender, age, family history, and cardiovascular disease. A predictive scoring system was created that identifies aneurysms more efficiently than current criteria and includes women, nonsmokers, and individuals aged <65 years. Using this model on national statistics of risk factors prevalence, we estimated 1.1 million AAAs in the United States, of which 569,000 are among women, nonsmokers, and individuals aged <65 years. CONCLUSIONS: Smoking cessation and a healthy lifestyle are associated with lower risk of AAA. We estimated that about half of the patients with AAA disease are not eligible for screening under current guidelines. We have created a high-yield screening algorithm that expands the target population for screening by including at-risk individuals not identified with existing screening criteria.", "author" : [ { "dropping-particle" : "", "family" : "Kent", "given" : "K C", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Zwolak", "given" : "R M", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Egorova", "given" : "N N", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Riles", "given" : "T S", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Manganaro", "given" : "A", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Moskowitz", "given" : "A J", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Gelijns", "given" : "A C", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Greco", "given" : "G", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "J Vasc Surg", "id" : "ITEM-2", "issue" : "3", "issued" : { "date-parts" : [ [ "2010" ] ] }, "note" : "Kent, K Craig\nZwolak, Robert M\nEgorova, Natalia N\nRiles, Thomas S\nManganaro, Andrew\nMoskowitz, Alan J\nGelijns, Annetine C\nGreco, Giampaolo\neng\nResearch Support, Non-U.S. Gov't\n2010/07/16 06:00\nJ Vasc Surg. 2010 Sep;52(3):539-48. doi: 10.1016/j.jvs.2010.05.090. Epub 2010 Jul 13.", "page" : "539-548", "title" : "Analysis of risk factors for abdominal aortic aneurysm in a cohort of more than 3 million individuals", "type" : "article-journal", "volume" : "52" }, "uris" : [ "http://www.mendeley.com/documents/?uuid=3ea5c140-d672-4d47-8383-af34c87509ff" ] }, { "id" : "ITEM-3", "itemData" : { "DOI" : "10.1016/j.jvs.2015.02.037", "ISBN" : "1097-6809 (Electronic)\r0741-5214 (Linking)", "PMID" : "26115925", "abstract" : "OBJECTIVE: Emerging evidence suggests high prevalence of abdominal aortic aneurysm (AAA) among patients with coronary disease. Accurate characterization of the association between coronary disease and AAA and of the actual prevalence of AAA among patients with angiography-verified coronary artery disease (CAD) is needed to evaluate the possible benefits of systematic screening for AAA. METHODS: We searched for studies that reported the association between AAA and CAD or coronary heart disease (CHD; wider phenotype definition) in the general population (randomized controlled trials, prospective population cohorts) and those that reported the prevalence of AAA among patients with angiography-verified CAD through PubMed, Embase, and reference lists for the period between 1980 and 2014. Random-effects models were applied because of the high heterogeneity between included studies. RESULTS: Among the general population, 23 studies reported the association between CHD and the occurrence of subclinical AAA (positive ultrasound screening; meta-analyzed odds ratio of 2.38 with 95% confidence interval [CI] of 1.78-3.19; P = 4.1 x 10(-9)). According to four prospective studies, CHD is a strong predictor of future AAA events (fatal and nonfatal; meta-analyzed hazard ratio of 3.49 with 95% CI of 2.56-4.76; P = 2.4 x 10(-15)). Altogether, 10 studies reported the prevalence of AAA among patients with angiography-verified CAD or undergoing coronary artery bypass grafting. Among men, meta-analyzed prevalence was 9.5% (95% CI, 7.6%-11.7%). Among men undergoing coronary artery bypass grafting or with three-vessel disease, the prevalence was 11.4% (95% CI, 9.1%-13.9%). Among women, the prevalence was low (0.35%). CONCLUSIONS: The risk of subclinical AAA and future AAA events is high among patients with coronary disease. Screening for AAA among CAD patients by cardiologists would be easy and inexpensive, with possible benefits to survival and risk evaluation.", "author" : [ { "dropping-particle" : "", "family" : "Hernesniemi", "given" : "J A", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Vanni", "given" : "V", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Hakala", "given" : "T", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "J Vasc Surg", "id" : "ITEM-3", "issue" : "1", "issued" : { "date-parts" : [ [ "2015" ] ] }, "note" : "Hernesniemi, Jussi A\nVanni, Ville\nHakala, Tapio\neng\nMeta-Analysis\nReview\n2015/06/28 06:00\nJ Vasc Surg. 2015 Jul;62(1):232-240.e3. doi: 10.1016/j.jvs.2015.02.037.", "page" : "232-240 e3", "title" : "The prevalence of abdominal aortic aneurysm is consistently high among patients with coronary artery disease", "type" : "article-journal", "volume" : "62" }, "uris" : [ "http://www.mendeley.com/documents/?uuid=71cceefc-d5c5-4cec-acb3-9543cae1e6dd" ] }, { "id" : "ITEM-4", "itemData" : { "DOI" : "10.1016/j.jvs.2008.08.012", "ISBN" : "1097-6809 (Electronic)\r0741-5214 (Linking)", "PMID" : "19028058", "abstract" : "BACKGROUND: Several studies have reported a familial clustering of abdominal aortic aneurysm (AAA) supporting that AAA is an inheritable disease, but few population-based studies can be found. Possible gender differences regarding hereditary patterns have been reported. OBJECTIVE: The aim of this study was to investigate the risk of developing an AAA for first-degree relatives of patients with AAA in Sweden and compare them with matched controls and their relatives. METHODS AND MATERIALS: All persons (3183) born after 1932, diagnosed with AAA between 2001 and 2005, and a random selection of 15,943 age-, gender-, and region-matched controls were included. First-degree relatives of cases and controls were identified via the Multigeneration Register. Family history of AAA for cases and controls was assessed by linking the relatives to the Hospital Discharge Register and Cause of Death Register. The data were analyzed by conditional logistic regression. RESULTS: The overall relative risk of AAA associated with family history compared to no family history was 1.9 (95% confidence interval [CI] 1.6-2.2). Comorbidities were more common among the cases than the controls (P < .0001) but the relative risks remained unchanged after adjustment for comorbidities. Stratification for absence or presence of comorbidities showed no significant difference between the two groups (P = .29). The relative risk of AAA for first-degree relatives was similar for women and men (P = .22 for gender differences), ie, the relative risk of AAA was not dependent on the gender of the index person. CONCLUSION: In this nationwide survey, the relative risk of developing AAA for first-degree relatives to persons diagnosed with AAA was approximately doubled compared to persons with no family history. Neither the gender of the index person nor the first-degree relative influenced the risk of AAA.", "author" : [ { "dropping-particle" : "", "family" : "Larsson", "given" : "E", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Granath", "given" : "F", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Swedenborg", "given" : "J", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Hultgren", "given" : "R", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "J Vasc Surg", "id" : "ITEM-4", "issue" : "1", "issued" : { "date-parts" : [ [ "2009" ] ] }, "note" : "Larsson, Emma\nGranath, Fredrik\nSwedenborg, Jesper\nHultgren, Rebecka\neng\nResearch Support, Non-U.S. Gov't\n2008/11/26 09:00\nJ Vasc Surg. 2009 Jan;49(1):47-50; discussion 51. doi: 10.1016/j.jvs.2008.08.012. Epub 2008 Nov 22.", "page" : "47-50; discussion 51", "title" : "A population-based case-control study of the familial risk of abdominal aortic aneurysm", "type" : "article-journal", "volume" : "49" }, "uris" : [ "http://www.mendeley.com/documents/?uuid=f2d6a5f9-ff21-41f6-894a-9b9bc0424344" ] }, { "id" : "ITEM-5", "itemData" : { "DOI" : "10.1016/j.avsg.2013.11.005", "ISBN" : "1615-5947 (Electronic)\r0890-5096 (Linking)", "PMID" : "24365082", "abstract" : "BACKGROUND: The objectives were to answer the following questions with the help of a well-characterized population in Liege, Belgium: 1) what percentage of patients with abdominal aortic aneurysm (AAA) have a positive family history for AAA? 2) what is the prevalence of AAAs among relatives of patients with AAA? and 3) do familial and sporadic AAA cases differ in clinical characteristics? METHODS: Patients with unrelated AAA diagnosed at the Cardiovascular Surgery Department, University Hospital of Liege, Belgium, between 1999 and 2012 were invited to the study. A detailed family history was obtained in interviews and recorded using Progeny software. We divided the 618 patients into 2 study groups: group I, 296 patients with AAA (268; 91% men) were followed up with computerized tomography combined with positron emission tomography; and group II, 322 patients with AAA (295; 92% men) whose families were invited to ultrasonographic screening. RESULTS: In the initial interview, 62 (10%) of the 618 patients with AAA reported a positive family history for AAA. Ultrasonographic screening identified 24 new AAAs among 186 relatives (>/=50 years) of 144 families yielding a prevalence of 13%. The highest prevalence (25%) was found among brothers. By combining the number of AAAs found by ultrasonographic screening with those diagnosed previously the observed lifetime prevalence of AAA was estimated to be 32% in brothers. The familial AAA cases were more likely to have a ruptured AAA than the sporadic cases (8% vs. 2.4%; P < 0.0001). CONCLUSIONS: The findings confirm previously found high prevalence of AAA among brothers, support genetic contribution to AAA pathogenesis, and provide rationale for targeted screening of relatives of patients with AAA.", "author" : [ { "dropping-particle" : "", "family" : "Sakalihasan", "given" : "N", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Defraigne", "given" : "J O", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Kerstenne", "given" : "M A", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Cheramy-Bien", "given" : "J P", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Smelser", "given" : "D T", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Tromp", "given" : "G", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Kuivaniemi", "given" : "H", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Ann Vasc Surg", "id" : "ITEM-5", "issue" : "4", "issued" : { "date-parts" : [ [ "2014" ] ] }, "note" : "Sakalihasan, Natzi\nDefraigne, Jean-Olivier\nKerstenne, Marie-Ange\nCheramy-Bien, Jean-Paul\nSmelser, Diane T\nTromp, Gerard\nKuivaniemi, Helena\neng\nR01 HL045996/HL/NHLBI NIH HHS/\nR01 HL064310/HL/NHLBI NIH HHS/\nComparative Study\nResearch Support, N.I.H., Extramural\nResearch Support, Non-U.S. Gov't\nNetherlands\n2013/12/25 06:00\nAnn Vasc Surg. 2014 May;28(4):787-97. doi: 10.1016/j.avsg.2013.11.005. Epub 2013 Dec 21.", "page" : "787-797", "title" : "Family members of patients with abdominal aortic aneurysms are at increased risk for aneurysms: analysis of 618 probands and their families from the Liege AAA Family Study", "type" : "article-journal", "volume" : "28" }, "uris" : [ "http://www.mendeley.com/documents/?uuid=2091f981-8e8c-4319-97f7-577911798f21" ] }, { "id" : "ITEM-6", "itemData" : { "DOI" : "10.1161/ATVBAHA.116.308147", "ISBN" : "1524-4636 (Electronic)\r1079-5642 (Linking)", "PMID" : "27834688", "abstract" : "OBJECTIVE: Abdominal aortic aneurysm (AAA) is an important vascular disease in older adults, but data on lifetime risk of AAA are sparse. We examined lifetime risk of AAA in a community-based cohort and prospectively assessed the association between midlife cardiovascular risk factors and AAAs. APPROACH AND RESULTS: In ARIC study (Atherosclerosis Risk in Communities), 15 792 participants were recruited at visit 1 in 1987 to 1989 and followed up through 2013. Longitudinal smoking status was defined using smoking behavior ascertained from visit 1 (1987-1989) to visit 4 (1996-1998). We followed up participants for incident, clinical AAAs using hospital discharge diagnoses, Medicare outpatient diagnoses, or death certificates through 2011 and identified 590 incident AAAs. An abdominal ultrasound was conducted in 2011 to 2013 in 5911 surviving participants, and 75 asymptomatic AAAs were identified. We estimated the lifetime risk of AAA from the index age 45 years through 85 years of age. At age 45, the lifetime risk for AAA was 5.6% (95% confidence interval, 4.8-6.1) and was higher in men (8.2%) and current smokers (10.5%). Smokers who quit smoking between visit 1 and visit 4 had a 29% lower AAA lifetime risk compared with continuous smokers but had a higher risk than pre-visit 1 quitters. The lifetime risk of rupture or medical intervention was 1.6% (95% confidence interval, 1.2-1.8). Smoking, white race, male sex, greater height, and greater low-density lipoprotein or total cholesterol were associated with an increased risk of clinical AAA and asymptomatic AAA. CONCLUSIONS: At least 1 in 9 middle-aged current smokers developed AAA in their lifetime. Smoking cessation reduced the lifetime risk of AAA.", "author" : [ { "dropping-particle" : "", "family" : "Tang", "given" : "W", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Yao", "given" : "L", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Roetker", "given" : "N S", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Alonso", "given" : "A", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Lutsey", "given" : "P L", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Steenson", "given" : "C C", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Lederle", "given" : "F A", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Hunter", "given" : "D W", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Bengtson", "given" : "L G", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Guan", "given" : "W", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Missov", "given" : "E", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Folsom", "given" : "A R", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Arterioscler Thromb Vasc Biol", "id" : "ITEM-6", "issue" : "12", "issued" : { "date-parts" : [ [ "2016" ] ] }, "note" : "Tang, Weihong\nYao, Lu\nRoetker, Nicholas S\nAlonso, Alvaro\nLutsey, Pamela L\nSteenson, Carol C\nLederle, Frank A\nHunter, David W\nBengtson, Lindsay G S\nGuan, Weihua\nMissov, Emil\nFolsom, Aaron R\neng\nHHSN268201100012C/HL/NHLBI NIH HHS/\nHHSN268201100009I/HL/NHLBI NIH HHS/\nHHSN268201100010C/HL/NHLBI NIH HHS/\nHHSN268201100008C/HL/NHLBI NIH HHS/\nHHSN268201100005G/HL/NHLBI NIH HHS/\nHHSN268201100008I/HL/NHLBI NIH HHS/\nHHSN268201100007C/HL/NHLBI NIH HHS/\nHHSN268201100011I/HL/NHLBI NIH HHS/\nHHSN268201100011C/HL/NHLBI NIH HHS/\nHHSN268201100006C/HL/NHLBI NIH HHS/\nHHSN268201100005I/HL/NHLBI NIH HHS/\nHHSN268201100009C/HL/NHLBI NIH HHS/\nHHSN268201100005C/HL/NHLBI NIH HHS/\nHHSN268201100007I/HL/NHLBI NIH HHS/\nR01 HL103695/HL/NHLBI NIH HHS/\nMulticenter Study\n2016/11/12 06:00\nArterioscler Thromb Vasc Biol. 2016 Dec;36(12):2468-2477. doi: 10.1161/ATVBAHA.116.308147. Epub 2016 Nov 10.", "page" : "2468-2477", "title" : "Lifetime Risk and Risk Factors for Abdominal Aortic Aneurysm in a 24-Year Prospective Study: The ARIC Study (Atherosclerosis Risk in Communities)", "type" : "article-journal", "volume" : "36" }, "uris" : [ "http://www.mendeley.com/documents/?uuid=3151d0ae-db80-4a12-9a4a-e43bda1a32cc" ] } ], "mendeley" : { "formattedCitation" : "11\u201316", "plainTextFormattedCitation" : "11\u201316", "previouslyFormattedCitation" : "11\u201316" }, "properties" : { }, "schema" : "https://github.com/citation-style-language/schema/raw/master/csl-citation.json" }1116 Current evidence based on molecular studies has demonstrated that atherosclerosis and AAA are distinct disease entities.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.18632/oncotarget.3848", "ISSN" : "1949-2553", "PMID" : "25944698", "abstract" : "Abdominal aortic aneurysm (AAA) and aortic occlusive disease (AOD) represent common causes of morbidity and mortality in elderly populations which were previously believed to have common aetiologies. The aim of this study was to assess the gene expression in human AAA and AOD. We performed microarrays using aortic specimen obtained from 20 patients with small AAAs (\u2264 55mm), 29 patients with large AAAs (> 55mm), 9 AOD patients, and 10 control aortic specimens obtained from organ donors. Some differentially expressed genes were validated by quantitative-PCR (qRT-PCR)/immunohistochemistry. We identified 840 and 1,014 differentially expressed genes in small and large AAAs, respectively. Immune-related pathways including cytokine-cytokine receptor interaction and T-cell-receptor signalling were upregulated in both small and large AAAs. Examples of validated genes included CTLA4 (2.01-fold upregulated in small AAA, P = 0.002), NKTR (2.37-and 2.66-fold upregulated in small and large AAA with P = 0.041 and P = 0.015, respectively), and CD8A (2.57-fold upregulated in large AAA, P = 0.004). 1,765 differentially expressed genes were identified in AOD. Pathways upregulated in AOD included metabolic and oxidative phosphorylation categories. The UCP2 gene was downregulated in AOD (3.73-fold downregulated, validated P = 0.017). In conclusion, the AAA and AOD transcriptomes were very different suggesting that AAA and AOD have distinct pathogenic mechanisms.", "author" : [ { "dropping-particle" : "", "family" : "Biros", "given" : "Erik", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "G\u00e4bel", "given" : "Gabor", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Moran", "given" : "Corey S.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Schreurs", "given" : "Charlotte", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Lindeman", "given" : "Jan H. N.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Walker", "given" : "Philip J.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Nataatmadja", "given" : "Maria", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "West", "given" : "Malcolm", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Holdt", "given" : "Lesca M.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Hinterseher", "given" : "Irene", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Pilarsky", "given" : "Christian", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Golledge", "given" : "Jonathan", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Oncotarget", "id" : "ITEM-1", "issue" : "15", "issued" : { "date-parts" : [ [ "2015", "5", "30" ] ] }, "page" : "12984-96", "title" : "Differential gene expression in human abdominal aortic aneurysm and aortic occlusive disease", "type" : "article-journal", "volume" : "6" }, "uris" : [ "http://www.mendeley.com/documents/?uuid=5bead374-ead4-3484-be3f-6ffa3ede81f2" ] } ], "mendeley" : { "formattedCitation" : "17", "plainTextFormattedCitation" : "17", "previouslyFormattedCitation" : "17" }, "properties" : { }, "schema" : "https://github.com/citation-style-language/schema/raw/master/csl-citation.json" }17 Diabetic patients have a lower risk of developing AAA than the general population, a distinguishing factor compared to occlusive atherothrombotic disease.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1016/j.ejvs.2011.12.026", "ISSN" : "10785884", "PMID" : "22237512", "abstract" : "In a 1997 report of a large abdominal aortic aneurysm (AAA) screening study, we observed a negative association between diabetes and AAA. Although this was not previously described and negative associations between diseases are rare, the credibility of the finding was supported by consistent results in several previous studies and by the absence of an obvious artifactual explanation. Since that time, a variety of studies of AAA diagnosis, both by screening and prospective clinical follow-up, have confirmed the finding. Other studies have reported slower aneurysm enlargement and fewer repairs for rupture in diabetics. The seeming protective effect of diabetes for AAA contrasts with its causal role in occlusive vascular disease and so provides a strong challenge to the traditional view of AAA as a manifestation of atherosclerosis. Research focused on a protective effect of diabetes has already increased our understanding of the etiology of AAA, and might eventually pave the way for new therapies to slow AAA progression.", "author" : [ { "dropping-particle" : "", "family" : "Lederle", "given" : "F.A.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "European Journal of Vascular and Endovascular Surgery", "id" : "ITEM-1", "issue" : "3", "issued" : { "date-parts" : [ [ "2012", "3" ] ] }, "page" : "254-256", "title" : "The Strange Relationship between Diabetes and Abdominal Aortic Aneurysm", "type" : "article-journal", "volume" : "43" }, "uris" : [ "http://www.mendeley.com/documents/?uuid=1c348066-57cd-3037-99db-16b6e557da63" ] } ], "mendeley" : { "formattedCitation" : "18", "plainTextFormattedCitation" : "18", "previouslyFormattedCitation" : "18" }, "properties" : { }, "schema" : "https://github.com/citation-style-language/schema/raw/master/csl-citation.json" }18 Diabetic patients also have a slower AAA growth rate. The possibility that metformin, a commonly used pharmaceutical oral drug used to manage type 2 diabetes, inhibits growth, has been addressed in several recent reports.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1002/bjs.8707", "ISBN" : "1365-2168 (Electronic)\r0007-1323 (Linking)", "PMID" : "22389113", "abstract" : "BACKGROUND: Surveillance is a common management strategy for small abdominal aortic aneurysm (AAA) (3.0-5.4 cm in diameter). Individual characteristics, other than diameter, may influence aneurysm growth or rupture rates. METHODS: Individual data were collated from 15 475 people under follow-up for a small aneurysm in 18 studies. The influence of co-variables (including demographics, medical and drug history) on aneurysm growth and rupture rates (analysed using longitudinal random-effects modelling and survival analysis with adjustment for aneurysm diameter) were summarized in an individual patient meta-analysis. RESULTS: The mean aneurysm growth rate of 2.21 mm/year was independent of age and sex. Growth rate was increased in smokers (by 0.35 mm/year) and decreased in patients with diabetes (by 0.51 mm/year). Mean arterial pressure had no effect and antihypertensive or other cardioprotective medications had only small, non-significant effects on aneurysm growth, consistent with the observation that calendar year of enrollment was not associated with growth rate. Rupture rates were almost fourfold higher in women than men (P < 0.001), were double in current smokers (P = 0.001) and increased with higher blood pressure (P = 0.001). CONCLUSION: Follow-up schedules for individuals with a small AAA may need to consider diabetes and smoking, in addition to aneurysm diameter. The differing risk factors for growth and rupture suggest that a lower threshold for surgical intervention in women may be justified. No single drug used for cardiovascular risk reduction had a major effect on the growth or rupture of small aneurysms.", "author" : [ { "dropping-particle" : "", "family" : "Sweeting", "given" : "M J", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Thompson", "given" : "S G", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Brown", "given" : "L C", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Powell", "given" : "J T", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "collaborators", "given" : "Rescan", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Br J Surg", "id" : "ITEM-1", "issue" : "5", "issued" : { "date-parts" : [ [ "2012" ] ] }, "note" : "Sweeting, M J\nThompson, S G\nBrown, L C\nPowell, J T\neng\n09/91/39/Department of Health/United Kingdom\nHTA/09/91/39/Department of Health/United Kingdom\nRG/08/014/24067/British Heart Foundation/United Kingdom\nMC_U105232027/Medical Research Council/United Kingdom\nMC_U105260792/Medical Research Council/United Kingdom\nMeta-Analysis\nResearch Support, Non-U.S. Gov't\nReview\nEngland\n2012/03/06 06:00\nBr J Surg. 2012 May;99(5):655-65. doi: 10.1002/bjs.8707. Epub 2012 Mar 5.", "page" : "655-665", "title" : "Meta-analysis of individual patient data to examine factors affecting growth and rupture of small abdominal aortic aneurysms", "type" : "article-journal", "volume" : "99" }, "uris" : [ "http://www.mendeley.com/documents/?uuid=79e835fb-08ec-489c-b3dd-52f59ba49dc8" ] }, { "id" : "ITEM-2", "itemData" : { "DOI" : "10.1002/bjs.10587", "ISSN" : "00071323", "PMID" : "28650557", "abstract" : "BACKGROUND It has been suggested that diabetes medications, such as metformin, may have effects that inhibit abdominal aortic aneurysm (AAA) growth. The aim of this study was to examine the association of diabetes treatments with AAA growth in three patient cohorts. METHODS AAA growth was studied using ultrasound surveillance in cohort 1, repeated CT in cohort 2 and more detailed repeat CT in cohort 3. Growth was estimated by the mean annual increase in maximum AAA diameter. RESULTS A total of 1697 patients with an AAA were studied, of whom 118, 39 and 16 patients were prescribed metformin for the treatment of diabetes in cohorts 1, 2 and 3 respectively. Prescription of metformin was associated with a reduced likelihood of median or greater AAA growth in all three cohorts (cohort 1: adjusted odds ratio (OR) 0\u00b759, 95 per cent c.i. 0\u00b739 to 0\u00b787, P = 0\u00b7008; cohort 2: adjusted OR 0\u00b738, 0\u00b718 to 0\u00b780, P = 0\u00b7011; cohort 3: adjusted OR 0\u00b713, 0\u00b703 to 0\u00b761, P = 0\u00b7010). No other diabetes treatment was significantly associated with AAA growth in any cohort. CONCLUSION These findings suggest a potential role for metformin in limiting AAA growth.", "author" : [ { "dropping-particle" : "", "family" : "Golledge", "given" : "J.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Moxon", "given" : "J.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Pinchbeck", "given" : "J.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Anderson", "given" : "G.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Rowbotham", "given" : "S.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Jenkins", "given" : "J.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Bourke", "given" : "M.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Bourke", "given" : "B.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Dear", "given" : "A.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Buckenham", "given" : "T.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Jones", "given" : "R.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Norman", "given" : "P. E.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "British Journal of Surgery", "id" : "ITEM-2", "issue" : "11", "issued" : { "date-parts" : [ [ "2017", "10" ] ] }, "page" : "1486-1493", "title" : "Association between metformin prescription and growth rates of abdominal aortic aneurysms", "type" : "article-journal", "volume" : "104" }, "uris" : [ "http://www.mendeley.com/documents/?uuid=2d4a5e3c-4ccc-3510-8b2b-9cfee5b7859d" ] } ], "mendeley" : { "formattedCitation" : "19,20", "plainTextFormattedCitation" : "19,20", "previouslyFormattedCitation" : "19,20" }, "properties" : { }, "schema" : "https://github.com/citation-style-language/schema/raw/master/csl-citation.json" }19,20 The lower prevalence, and later development of disease in women is possibly partly explained by a sex-hormone related protection, equivalent to that in other manifestations of cardiovascular diseases. It is highly probable that smoking is a more detrimental risk factor in women than in men, perhaps modulated by effect of smoking on the reproductive function in women, such as premature menopause, and negative effects on lipid levels. .ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "ISBN" : "0741-5214 (Print)\r0741-5214 (Linking)", "PMID" : "12891116", "abstract" : "OBJECTIVE: Aortic aneurysm has traditionally been considered a manifestation of atherosclerosis, but recent evidence suggests an independent pathogenesis, possibly similar to that of chronic obstructive pulmonary disease (COPD). Further insight into the pathogenesis of aortic aneurysm might be obtained by comparing its association with smoking with that of other smoking-related diseases. STUDY DESIGN: We conducted a systematic review of studies providing relative risk associated with smoking for both aortic aneurysm and other smoking-related diseases. RESULTS: We identified 10 eligible studies, which included more than 3 million subjects. The events reported in 9 studies were death from target diseases; the tenth study reported new diagnoses. Relative risk for aortic aneurysm-related events in current smokers was generally 3 to 6, compared with 1 to 2 for coronary artery disease or cerebrovascular disease and 5 to 12 for COPD. For each category of smoking in each study, relative risk associated with smoking was substantially greater for aortic aneurysm than for coronary artery disease or cerebrovascular disease. Our pooled estimates indicate that, in men, the association of ever smoking with aortic aneurysm is 2.5 times greater than the association of ever smoking with coronary artery disease (95% confidence interval [CI], 2.2, 2.8) and 3.5 times greater than the association of ever smoking with cerebrovascular disease (95% CI, 2.4, 5.3), but only 0.56 as great as the association of ever smoking with COPD (95% CI, 0.36, 0.86). CONCLUSIONS: The difference in magnitude of these associations with smoking is consistent with a non-atherosclerotic cause for aortic aneurysm and/or a stronger effect of smoking on vascular disease in the peripheral arteries.", "author" : [ { "dropping-particle" : "", "family" : "Lederle", "given" : "F A", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Nelson", "given" : "D B", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Joseph", "given" : "A M", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "J Vasc Surg", "id" : "ITEM-1", "issue" : "2", "issued" : { "date-parts" : [ [ "2003" ] ] }, "note" : "Lederle, Frank A\nNelson, David B\nJoseph, Anne M\neng\nResearch Support, U.S. Gov't, Non-P.H.S.\nReview\n2003/08/02 05:00\nJ Vasc Surg. 2003 Aug;38(2):329-34.", "page" : "329-334", "title" : "Smokers' relative risk for aortic aneurysm compared with other smoking-related diseases: a systematic review", "type" : "article-journal", "volume" : "38" }, "uris" : [ "http://www.mendeley.com/documents/?uuid=71972392-c623-461f-bd1b-125d811b74f9" ] }, { "id" : "ITEM-2", "itemData" : { "DOI" : "10.1002/bjs.10225", "ISBN" : "1365-2168 (Electronic)\r0007-1323 (Linking)", "PMID" : "27346306", "abstract" : "BACKGROUND: Although women represent an increasing proportion of those presenting with abdominal aortic aneurysm (AAA) rupture, the current prevalence of AAA in women is unknown. The contemporary population prevalence of screen-detected AAA in women was investigated by both age and smoking status. METHODS: A systematic review was undertaken of studies screening for AAA, including over 1000 women, aged at least 60 years, done since the year 2000. Studies were identified by searching MEDLINE, Embase and CENTRAL databases until 13 January 2016. Study quality was assessed using the Newcastle-Ottawa scoring system. RESULTS: Eight studies were identified, including only three based on population registers. The largest studies were based on self-purchase of screening. Altogether 1 537 633 women were screened. Overall AAA prevalence rates were very heterogeneous, ranging from 0.37 to 1.53 per cent: pooled prevalence 0.74 (95 per cent c.i. 0.53 to 1.03) per cent. The pooled prevalence increased with both age (more than 1 per cent for women aged over 70 years) and smoking (more than 1 per cent for ever smokers and over 2 per cent in current smokers). CONCLUSION: The current population prevalence of screen-detected AAA in older women is subject to wide demographic variation. However, in ever smokers and those over 70 years of age, the prevalence is over 1 per cent.", "author" : [ { "dropping-particle" : "", "family" : "Ulug", "given" : "P", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Powell", "given" : "J T", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Sweeting", "given" : "M J", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Bown", "given" : "M J", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Thompson", "given" : "S G", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Group", "given" : "Swan Collaborative", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Br J Surg", "id" : "ITEM-2", "issue" : "9", "issued" : { "date-parts" : [ [ "2016" ] ] }, "note" : "Ulug, P\nPowell, J T\nSweeting, M J\nBown, M J\nThompson, S G\neng\nHTA/14/179/01/Department of Health/United Kingdom\nMeta-Analysis\nReview\nEngland\n2016/06/28 06:00\nBr J Surg. 2016 Aug;103(9):1097-104. doi: 10.1002/bjs.10225. Epub 2016 Jun 27.", "page" : "1097-1104", "title" : "Meta-analysis of the current prevalence of screen-detected abdominal aortic aneurysm in women", "type" : "article-journal", "volume" : "103" }, "uris" : [ "http://www.mendeley.com/documents/?uuid=f13a04ba-5964-4a87-b7f6-3db2c7541b0f" ] }, { "id" : "ITEM-3", "itemData" : { "DOI" : "10.1016/j.maturitas.2017.12.012", "ISBN" : "1873-4111 (Electronic)\r0378-5122 (Linking)", "PMID" : "29452784", "abstract" : "OBJECTIVE: Abdominal aortic aneurysm (AAA) predominantly affects an elderly male population. Even so, AAA appears more detrimental in women, who experience a higher risk of aneurysm rupture and a worse outcome after surgery than men. Why women are privileged from yet are worse off once affected has been attributed to an effect of sex hormones. This review summarizes the knowledge of sex differences in AAA and addresses the changes in the aneurysm wall from a gender perspective. METHOD: Standard reporting guidelines set by the PRISMA Group were followed to identify studies examining AAA from a gender perspective. Relevant reports were identified using two electronic databases: PubMed and Web of Science. The systematic search was performed in two stages: firstly, using the terms AAA and gender/sex/women; and secondly, adding the terms \"elastin\", \"collagen\" and \"vascular smooth muscle cells\", in order to filter the search for studies relevant to our focus on the aneurysm wall. CONCLUSION: Current studies support the theory that sex has an effect on aneurysm formation, yet are inconclusive about whether or not aneurysm formation is dependent on female/male sex hormones or a lack thereof. The studies in women are scarce and out of those most reports primarily address other end-points, which limit their ability to illuminate an effect of sex on aneurysm formation. The complexity of the human menstrual cycle and menopausal transition are difficult to mimic in animal models, which limit their applicability to AAA formation in humans.", "author" : [ { "dropping-particle" : "", "family" : "Villard", "given" : "C", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Hultgren", "given" : "R", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Maturitas", "id" : "ITEM-3", "issued" : { "date-parts" : [ [ "2018" ] ] }, "note" : "Villard, Christina\nHultgren, Rebecka\neng\nReview\nIreland\n2018/02/18 06:00\nMaturitas. 2018 Mar;109:63-69. doi: 10.1016/j.maturitas.2017.12.012. Epub 2017 Dec 13.", "page" : "63-69", "title" : "Abdominal aortic aneurysm: Sex differences", "type" : "article-journal", "volume" : "109" }, "uris" : [ "http://www.mendeley.com/documents/?uuid=b6e93bfa-89d3-4bd9-9b29-82005cbbae98" ] }, { "id" : "ITEM-4", "itemData" : { "DOI" : "10.1016/j.jvs.2016.10.074", "ISBN" : "1097-6809 (Electronic)\r0741-5214 (Linking)", "PMID" : "28342508", "abstract" : "OBJECTIVE: Finite element analysis (FEA) has been suggested to be superior to maximal diameter measurements in predicting rupture of abdominal aortic aneurysms (AAAs). Our objective was to investigate to what extent previously described rupture risk factors were associated with FEA-estimated rupture risk. METHODS: One hundred forty-six patients with an asymptomatic AAA of a 40- to 60-mm diameter were retrospectively identified and consecutively included. The patients' computed tomography angiograms were analyzed by FEA without (neutral) and with (specific) input of patient-specific mean arterial pressure (MAP), gender, family history, and age. The maximal wall stress/wall strength ratio was described as a rupture risk equivalent diameter (RRED), which translated this ratio into an average aneurysm diameter of corresponding rupture risk. RESULTS: In multivariate linear regression, RREDneutral increased with female gender (3.7 mm; 95% confidence interval [CI], 0.13-7.3) and correlated with patient height (0.27 mm/cm; 95% CI, 0.11-0.43) and body surface area (BSA, 16 mm/m(2); 95% CI, 8.3-24) and inversely with body mass index (BMI, -0.40 mm/kg m(-2); 95% CI, -0.75 to -0.054) in a wall stress-dependent manner. Wall stress-adjusted RREDneutral was raised if the patient was currently smoking (1.1 mm; 95% CI, 0.21-1.9). Age, MAP, family history, and patient weight were unrelated to RREDneutral. In specific FEA, RREDspecific increased with female gender, MAP, family history positive for AAA, height, and BSA, whereas it was inversely related to BMI. All results were independent of aneurysm diameter. Peak wall stress and RRED correlated with aneurysm diameter and lumen volume. CONCLUSIONS: Female gender, current smoking, increased patient height and BSA, and low BMI were found to increase the mechanical rupture risk of AAAs. Previously described rupture risk factors may in part be explained by patient characteristic-dependent variations in aneurysm biomechanics.", "author" : [ { "dropping-particle" : "", "family" : "Lindquist Liljeqvist", "given" : "M", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Hultgren", "given" : "R", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Siika", "given" : "A", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Gasser", "given" : "T C", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Roy", "given" : "J", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "J Vasc Surg", "id" : "ITEM-4", "issue" : "4", "issued" : { "date-parts" : [ [ "2017" ] ] }, "note" : "Lindquist Liljeqvist, Moritz\nHultgren, Rebecka\nSiika, Antti\nGasser, T Christian\nRoy, Joy\neng\n2017/03/28 06:00\nJ Vasc Surg. 2017 Apr;65(4):1014-1021.e4. doi: 10.1016/j.jvs.2016.10.074.", "page" : "1014-1021 e4", "title" : "Gender, smoking, body size, and aneurysm geometry influence the biomechanical rupture risk of abdominal aortic aneurysms as estimated by finite element analysis", "type" : "article-journal", "volume" : "65" }, "uris" : [ "http://www.mendeley.com/documents/?uuid=53d90a21-aa21-435a-a962-6a09127b1ac4" ] } ], "mendeley" : { "formattedCitation" : "11,21\u201323", "plainTextFormattedCitation" : "11,21\u201323", "previouslyFormattedCitation" : "11,21\u201323" }, "properties" : { }, "schema" : "https://github.com/citation-style-language/schema/raw/master/csl-citation.json" }11,2123
[H3] Genetic risk factors for AAA
Aortic aneurysms can be found in patients with rare genetic diseases, such as the Ehlers-Danlos syndrome type IV (also known as the vascular type), the Marfan syndrome, and fibromuscular dystrophy.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "author" : [ { "dropping-particle" : "", "family" : "Beckman", "given" : "J A", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Creager", "given" : "M A", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "edition" : "Vasc Med. ", "editor" : [ { "dropping-particle" : "", "family" : "Creager", "given" : "M A", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Dzau", "given" : "V J", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Loscalzo", "given" : "J", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "id" : "ITEM-1", "issued" : { "date-parts" : [ [ "2006" ] ] }, "page" : "560-569", "title" : "Aortic aneurysms: Clinical evaluation", "type" : "chapter" }, "uris" : [ "http://www.mendeley.com/documents/?uuid=0fdb1608-acee-45d4-bc50-3b5c5bc5d385" ] } ], "mendeley" : { "formattedCitation" : "24", "plainTextFormattedCitation" : "24", "previouslyFormattedCitation" : "24" }, "properties" : { }, "schema" : "https://github.com/citation-style-language/schema/raw/master/csl-citation.json" }24 The common garden-variety AAA has no association to these rare genetic diseases, but is a complex, multifactorial late-age-at-onset disease w i t h b o t h g e n e t i c a n d e n v i r o n m e n t a l r i s k f a c t o r s . A b o u t 1 0 "2 0 % o f A A A p a t i e n t s h a v e a t l e a s t o n e r e l a t i v e w i t h A A A A D D I N C S L _ C I T A T I O N { " c i t a t i o n I t e m s " : [ { " i d " : " I T E M - 1 " , " i t e m D a t a " : { " D O I " : " 1 0 . 1 0 6 7 / m v a . 2 0 0 3 . 7 1 " , " I S B N " : " 0 7 4 1 - 5 2 1 4 ( P r i n t ) \ r 0 7 4 1 - 5214 (Linking)", "PMID" : "12563204", "abstract" : "OBJECTIVE: This study investigated a large number of families in which at least two individuals were diagnosed with abdominal aortic aneurysms to identify the relationship of the affected relatives to the proband. SUBJECTS AND METHODS: Families for the study were recruited through various vascular surgery centers in the United States, Finland, Belgium, Canada, the Netherlands, Sweden, and the United Kingdom and through our patient recruitment website (www.genetics.wayne.edu/ags). RESULTS: We identified 233 families with at least two individuals diagnosed with abdominal aortic aneurysms. The families originated from nine different nationalities, but all were white. There were 653 aneurysm patients in these families, with an average of 2.8 cases per family. Most of the families were small, with only two affected individuals. There were, however, six families with six, three with seven, and one with eight affected individuals. Most of the probands (82%) and the affected relatives (77%) were male, and the most common relationship to the proband was brother. Most of the families (72%) appeared to show autosomal recessive inheritance pattern, whereas in 58 families (25%), abdominal aortic aneurysms were inherited in autosomal dominant manner, and in eight families, the familial aggregation could be explained by autosomal dominant inheritance with incomplete penetrance. In the 66 families where abdominal aortic aneurysms were inherited in a dominant manner, 141 transmissions of the disease from one generation to another were identified, and the male-to-male, male-to-female, female-to-male, and female-to-female transmissions occurred in 46%, 11%, 32%, and 11%, respectively. CONCLUSION: Our study supports previous studies about familial aggregation of abdominal aortic aneurysms and suggests that first-degree family members, male relatives, in particular, are at increased risk. No single inheritance mode could explain the occurrence of abdominal aortic aneurysms in the 233 families studied here, suggesting that abdominal aortic aneursyms are a multifactorial disorder with multiple genetic and environmental risk factors.", "author" : [ { "dropping-particle" : "", "family" : "Kuivaniemi", "given" : "H", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Shibamura", "given" : "H", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Arthur", "given" : "C", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Berguer", "given" : "R", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Cole", "given" : "C W", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Juvonen", "given" : "T", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Kline", "given" : "R A", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Limet", "given" : "R", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Mackean", "given" : "G", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Norrgard", "given" : "O", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Pals", "given" : "G", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Powell", "given" : "J T", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Rainio", "given" : "P", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Sakalihasan", "given" : "N", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Vlijmen-van Keulen", "given" : "C", "non-dropping-particle" : "van", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Verloes", "given" : "A", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Tromp", "given" : "G", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "J Vasc Surg", "id" : "ITEM-1", "issue" : "2", "issued" : { "date-parts" : [ [ "2003" ] ] }, "note" : "Kuivaniemi, Helena\nShibamura, Hidenori\nArthur, Claudette\nBerguer, Ramon\nCole, C William\nJuvonen, Tatu\nKline, Ronald A\nLimet, Raymond\nMackean, Gerry\nNorrgard, Orjan\nPals, Gerard\nPowell, Janet T\nRainio, Pekka\nSakalihasan, Natzi\nvan Vlijmen-van Keulen, Clarissa\nVerloes, Alain\nTromp, Gerard\neng\nR01 HL064310/HL/NHLBI NIH HHS/\nHL 64310/HL/NHLBI NIH HHS/\nResearch Support, U.S. Gov't, P.H.S.\n2003/02/04 04:00\nJ Vasc Surg. 2003 Feb;37(2):340-5. doi: 10.1067/mva.2003.71.", "page" : "340-345", "title" : "Familial abdominal aortic aneurysms: collection of 233 multiplex families", "type" : "article-journal", "volume" : "37" }, "uris" : [ "http://www.mendeley.com/documents/?uuid=f87f6083-d761-4da8-bb6e-c5979f55a59f" ] }, { "id" : "ITEM-2", "itemData" : { "DOI" : "10.1016/j.avsg.2013.11.005", "ISBN" : "1615-5947 (Electronic)\r0890-5096 (Linking)", "PMID" : "24365082", "abstract" : "BACKGROUND: The objectives were to answer the following questions with the help of a well-characterized population in Liege, Belgium: 1) what percentage of patients with abdominal aortic aneurysm (AAA) have a positive family history for AAA? 2) what is the prevalence of AAAs among relatives of patients with AAA? and 3) do familial and sporadic AAA cases differ in clinical characteristics? METHODS: Patients with unrelated AAA diagnosed at the Cardiovascular Surgery Department, University Hospital of Liege, Belgium, between 1999 and 2012 were invited to the study. A detailed family history was obtained in interviews and recorded using Progeny software. We divided the 618 patients into 2 study groups: group I, 296 patients with AAA (268; 91% men) were followed up with computerized tomography combined with positron emission tomography; and group II, 322 patients with AAA (295; 92% men) whose families were invited to ultrasonographic screening. RESULTS: In the initial interview, 62 (10%) of the 618 patients with AAA reported a positive family history for AAA. Ultrasonographic screening identified 24 new AAAs among 186 relatives (>/=50 years) of 144 families yielding a prevalence of 13%. The highest prevalence (25%) was found among brothers. By combining the number of AAAs found by ultrasonographic screening with those diagnosed previously the observed lifetime prevalence of AAA was estimated to be 32% in brothers. The familial AAA cases were more likely to have a ruptured AAA than the sporadic cases (8% vs. 2.4%; P < 0.0001). CONCLUSIONS: The findings confirm previously found high prevalence of AAA among brothers, support genetic contribution to AAA pathogenesis, and provide rationale for targeted screening of relatives of patients with AAA.", "author" : [ { "dropping-particle" : "", "family" : "Sakalihasan", "given" : "N", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Defraigne", "given" : "J O", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Kerstenne", "given" : "M A", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Cheramy-Bien", "given" : "J P", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Smelser", "given" : "D T", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Tromp", "given" : "G", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Kuivaniemi", "given" : "H", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Ann Vasc Surg", "id" : "ITEM-2", "issue" : "4", "issued" : { "date-parts" : [ [ "2014" ] ] }, "note" : "Sakalihasan, Natzi\nDefraigne, Jean-Olivier\nKerstenne, Marie-Ange\nCheramy-Bien, Jean-Paul\nSmelser, Diane T\nTromp, Gerard\nKuivaniemi, Helena\neng\nR01 HL045996/HL/NHLBI NIH HHS/\nR01 HL064310/HL/NHLBI NIH HHS/\nComparative Study\nResearch Support, N.I.H., Extramural\nResearch Support, Non-U.S. Gov't\nNetherlands\n2013/12/25 06:00\nAnn Vasc Surg. 2014 May;28(4):787-97. doi: 10.1016/j.avsg.2013.11.005. Epub 2013 Dec 21.", "page" : "787-797", "title" : "Family members of patients with abdominal aortic aneurysms are at increased risk for aneurysms: analysis of 618 probands and their families from the Liege AAA Family Study", "type" : "article-journal", "volume" : "28" }, "uris" : [ "http://www.mendeley.com/documents/?uuid=2091f981-8e8c-4319-97f7-577911798f21" ] } ], "mendeley" : { "formattedCitation" : "15,25", "plainTextFormattedCitation" : "15,25", "previouslyFormattedCitation" : "15,25" }, "properties" : { }, "schema" : "https://github.com/citation-style-language/schema/raw/master/csl-citation.json" }15,25 About 1 0 "2 0 % o f A A A p a t i e n t s h a v e a t l e a s t o n e r e l a t i v e w i t h t h i s c o n d i t i o n A D D I N C S L _ C I T A T I O N { " c i t a t i o n I t e m s " : [ { " i d " : " I T E M - 1 " , " i t e m D a t a " : { " D O I " : " 1 0 . 1 0 6 7 / m v a . 2 0 0 3 . 7 1 " , " I S B N " : " 0 7 4 1 - 5 2 1 4 ( P r i n t ) \ r 0 7 4 1 - 5 2 1 4 ( L i n k i n g ) " , " P M I D " : " 1 2 5 6 3 2 0 4 " , " a b s t r a ct" : "OBJECTIVE: This study investigated a large number of families in which at least two individuals were diagnosed with abdominal aortic aneurysms to identify the relationship of the affected relatives to the proband. SUBJECTS AND METHODS: Families for the study were recruited through various vascular surgery centers in the United States, Finland, Belgium, Canada, the Netherlands, Sweden, and the United Kingdom and through our patient recruitment website (www.genetics.wayne.edu/ags). RESULTS: We identified 233 families with at least two individuals diagnosed with abdominal aortic aneurysms. The families originated from nine different nationalities, but all were white. There were 653 aneurysm patients in these families, with an average of 2.8 cases per family. Most of the families were small, with only two affected individuals. There were, however, six families with six, three with seven, and one with eight affected individuals. Most of the probands (82%) and the affected relatives (77%) were male, and the most common relationship to the proband was brother. Most of the families (72%) appeared to show autosomal recessive inheritance pattern, whereas in 58 families (25%), abdominal aortic aneurysms were inherited in autosomal dominant manner, and in eight families, the familial aggregation could be explained by autosomal dominant inheritance with incomplete penetrance. In the 66 families where abdominal aortic aneurysms were inherited in a dominant manner, 141 transmissions of the disease from one generation to another were identified, and the male-to-male, male-to-female, female-to-male, and female-to-female transmissions occurred in 46%, 11%, 32%, and 11%, respectively. CONCLUSION: Our study supports previous studies about familial aggregation of abdominal aortic aneurysms and suggests that first-degree family members, male relatives, in particular, are at increased risk. No single inheritance mode could explain the occurrence of abdominal aortic aneurysms in the 233 families studied here, suggesting that abdominal aortic aneursyms are a multifactorial disorder with multiple genetic and environmental risk factors.", "author" : [ { "dropping-particle" : "", "family" : "Kuivaniemi", "given" : "H", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Shibamura", "given" : "H", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Arthur", "given" : "C", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Berguer", "given" : "R", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Cole", "given" : "C W", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Juvonen", "given" : "T", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Kline", "given" : "R A", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Limet", "given" : "R", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Mackean", "given" : "G", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Norrgard", "given" : "O", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Pals", "given" : "G", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Powell", "given" : "J T", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Rainio", "given" : "P", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Sakalihasan", "given" : "N", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Vlijmen-van Keulen", "given" : "C", "non-dropping-particle" : "van", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Verloes", "given" : "A", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Tromp", "given" : "G", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "J Vasc Surg", "id" : "ITEM-1", "issue" : "2", "issued" : { "date-parts" : [ [ "2003" ] ] }, "note" : "Kuivaniemi, Helena\nShibamura, Hidenori\nArthur, Claudette\nBerguer, Ramon\nCole, C William\nJuvonen, Tatu\nKline, Ronald A\nLimet, Raymond\nMackean, Gerry\nNorrgard, Orjan\nPals, Gerard\nPowell, Janet T\nRainio, Pekka\nSakalihasan, Natzi\nvan Vlijmen-van Keulen, Clarissa\nVerloes, Alain\nTromp, Gerard\neng\nR01 HL064310/HL/NHLBI NIH HHS/\nHL 64310/HL/NHLBI NIH HHS/\nResearch Support, U.S. Gov't, P.H.S.\n2003/02/04 04:00\nJ Vasc Surg. 2003 Feb;37(2):340-5. doi: 10.1067/mva.2003.71.", "page" : "340-345", "title" : "Familial abdominal aortic aneurysms: collection of 233 multiplex families", "type" : "article-journal", "volume" : "37" }, "uris" : [ "http://www.mendeley.com/documents/?uuid=f87f6083-d761-4da8-bb6e-c5979f55a59f" ] }, { "id" : "ITEM-2", "itemData" : { "DOI" : "10.1016/j.avsg.2013.11.005", "ISBN" : "1615-5947 (Electronic)\r0890-5096 (Linking)", "PMID" : "24365082", "abstract" : "BACKGROUND: The objectives were to answer the following questions with the help of a well-characterized population in Liege, Belgium: 1) what percentage of patients with abdominal aortic aneurysm (AAA) have a positive family history for AAA? 2) what is the prevalence of AAAs among relatives of patients with AAA? and 3) do familial and sporadic AAA cases differ in clinical characteristics? METHODS: Patients with unrelated AAA diagnosed at the Cardiovascular Surgery Department, University Hospital of Liege, Belgium, between 1999 and 2012 were invited to the study. A detailed family history was obtained in interviews and recorded using Progeny software. We divided the 618 patients into 2 study groups: group I, 296 patients with AAA (268; 91% men) were followed up with computerized tomography combined with positron emission tomography; and group II, 322 patients with AAA (295; 92% men) whose families were invited to ultrasonographic screening. RESULTS: In the initial interview, 62 (10%) of the 618 patients with AAA reported a positive family history for AAA. Ultrasonographic screening identified 24 new AAAs among 186 relatives (>/=50 years) of 144 families yielding a prevalence of 13%. The highest prevalence (25%) was found among brothers. By combining the number of AAAs found by ultrasonographic screening with those diagnosed previously the observed lifetime prevalence of AAA was estimated to be 32% in brothers. The familial AAA cases were more likely to have a ruptured AAA than the sporadic cases (8% vs. 2.4%; P < 0.0001). CONCLUSIONS: The findings confirm previously found high prevalence of AAA among brothers, support genetic contribution to AAA pathogenesis, and provide rationale for targeted screening of relatives of patients with AAA.", "author" : [ { "dropping-particle" : "", "family" : "Sakalihasan", "given" : "N", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Defraigne", "given" : "J O", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Kerstenne", "given" : "M A", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Cheramy-Bien", "given" : "J P", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Smelser", "given" : "D T", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Tromp", "given" : "G", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Kuivaniemi", "given" : "H", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Ann Vasc Surg", "id" : "ITEM-2", "issue" : "4", "issued" : { "date-parts" : [ [ "2014" ] ] }, "note" : "Sakalihasan, Natzi\nDefraigne, Jean-Olivier\nKerstenne, Marie-Ange\nCheramy-Bien, Jean-Paul\nSmelser, Diane T\nTromp, Gerard\nKuivaniemi, Helena\neng\nR01 HL045996/HL/NHLBI NIH HHS/\nR01 HL064310/HL/NHLBI NIH HHS/\nComparative Study\nResearch Support, N.I.H., Extramural\nResearch Support, Non-U.S. Gov't\nNetherlands\n2013/12/25 06:00\nAnn Vasc Surg. 2014 May;28(4):787-97. doi: 10.1016/j.avsg.2013.11.005. Epub 2013 Dec 21.", "page" : "787-797", "title" : "Family members of patients with abdominal aortic aneurysms are at increased risk for aneurysms: analysis of 618 probands and their families from the Liege AAA Family Study", "type" : "article-journal", "volume" : "28" }, "uris" : [ "http://www.mendeley.com/documents/?uuid=2091f981-8e8c-4319-97f7-577911798f21" ] } ], "mendeley" : { "formattedCitation" : "15,25", "plainTextFormattedCitation" : "15,25", "previouslyFormattedCitation" : "15,25" }, "properties" : { }, "schema" : "https://github.com/citation-style-language/schema/raw/master/csl-citation.json" }15,25 [Au: please specify which one of the three] and formal segregation analyses indicate that genetic models explain this familial aggregation.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "ISBN" : "0002-9297 (Print)\r0002-9297 (Linking)", "PMID" : "1985458", "abstract" : "To determine the mode of inheritance of abdominal aortic aneurysm, data on first-degree relatives of 91 probands were collected. Results of segregation analysis performed on these data are reported. Many models, including nongenetic and genetic models, were compared using likelihood methods. The nongenetic model was rejected; statistically significant evidence in favor of a genetic model was found. Among the many genetic models compared, the most parsimonious genetic model was that susceptibility to abdominal aortic aneurysm is determined by a recessive gene at an autosomal diallelic major locus. A multifactorial component in addition to the major locus does not increase the likelihood of the data significantly.", "author" : [ { "dropping-particle" : "", "family" : "Majumder", "given" : "P P", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "St Jean", "given" : "P L", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Ferrell", "given" : "R E", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Webster", "given" : "M W", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Steed", "given" : "D L", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Am J Hum Genet", "id" : "ITEM-1", "issue" : "1", "issued" : { "date-parts" : [ [ "1991" ] ] }, "note" : "Majumder, P P\nSt Jean, P L\nFerrell, R E\nWebster, M W\nSteed, D L\neng\nResearch Support, Non-U.S. Gov't\n1991/01/01 00:00\nAm J Hum Genet. 1991 Jan;48(1):164-70.", "page" : "164-170", "title" : "On the inheritance of abdominal aortic aneurysm", "type" : "article-journal", "volume" : "48" }, "uris" : [ "http://www.mendeley.com/documents/?uuid=6506b2f7-c9ec-4eeb-93b6-297242594791" ] }, { "id" : "ITEM-2", "itemData" : { "ISBN" : "0741-5214 (Print)\r0741-5214 (Linking)", "PMID" : "7707569", "abstract" : "PURPOSE: Familial clustering of abdominal aortic aneurysm was first noticed in 1977. METHODS: Through questionnaire and phone inquiry, familial data on 324 probands with abdominal aortic aneurysms allowed the establishment of 313 multigenerational pedigrees including 39 with multiple affected patients. RESULTS: There were 276 sporadic cases (264 men, 12 women); 81 cases belonged to multiplex pedigrees (76 men; 5 women). We compared familial and sporadic male cases; the ages at diagnosis were 64.1 +/- 7.9 years and 66.0 +/- 7.3 years (p < 0.05), respectively, the ages at rupture were 65.4 +/- 6.6 years and 75.2 +/- 8.6 years (p < 0.001), and the rupture rate was 32.4% and 8.7% (p < 0.001). Survival curves were computed. Relative risk for male siblings of a male patient was 18. We performed a segregation analysis with the mixed model, the most likely explanation for occurrence of abdominal aortic aneurysm in our families was a single gene effect showing dominant inheritance. The frequency of the morbid allele was 1:250, and its age-related penetrance was not higher than 0.4. CONCLUSION: This analysis indicates the preeminence of genetic factors on multifactorial/environmental effects of the pathogenesis of abdominal aortic aneurysm.", "author" : [ { "dropping-particle" : "", "family" : "Verloes", "given" : "A", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Sakalihasan", "given" : "N", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Koulischer", "given" : "L", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Limet", "given" : "R", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "J Vasc Surg", "id" : "ITEM-2", "issue" : "4", "issued" : { "date-parts" : [ [ "1995" ] ] }, "note" : "Verloes, A\nSakalihasan, N\nKoulischer, L\nLimet, R\neng\nComparative Study\n1995/04/01 00:00\nJ Vasc Surg. 1995 Apr;21(4):646-55.", "page" : "646-655", "title" : "Aneurysms of the abdominal aorta: familial and genetic aspects in three hundred thirteen pedigrees", "type" : "article-journal", "volume" : "21" }, "uris" : [ "http://www.mendeley.com/documents/?uuid=2010d56b-d3c9-4fd0-8af5-b5acdfb10231" ] } ], "mendeley" : { "formattedCitation" : "26,27", "plainTextFormattedCitation" : "26,27", "previouslyFormattedCitation" : "26,27" }, "properties" : { }, "schema" : "https://github.com/citation-style-language/schema/raw/master/csl-citation.json" }26,27 Based on two large twin studies from Sweden ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1016/j.jvs.2009.08.036", "ISBN" : "1097-6809 (Electronic)\r0741-5214 (Linking)", "PMID" : "19939604", "abstract" : "BACKGROUND: The contribution of hereditary and environmental factors to the development of abdominal aortic aneurysms (AAAs) is still partly unknown. The aim of this study was to analyze the role of these factors in a large population-based sample of twins. METHODS: The Swedish Twin Registry, containing data on twins born in the country since 1886, was cross-linked with the Inpatient Registry, providing national coverage of discharge diagnoses coded according to the International Classification of Diseases (ICD). All twins with an infrarenal AAA were identified. Concordance rates and tetrachoric correlations were calculated for monozygotic (MZ) and dizygotic (DZ) twins. Tetrachoric correlations were calculated assuming an underlying normal distribution of liability, with multiple factors contributing additively and a threshold value that discriminates between AAA and no AAA. Higher concordance rates and correlations of liability in MZ twins than in DZ twins suggest that genetic factors influence disease development. Structural equation modeling techniques, Mx-analyses, were used to estimate the contributions of genetic effects as well as shared and nonshared environmental factors for development of AAA. RESULTS: There were 172,890 twins registered at the time of the study including 265 twins (81% men; mean age 72 years; range, 48-94) with AAA. There were 7 MZ and 5 DZ concordant pairs as well as 44 MZ and 197 DZ discordant pairs with AAA. The probandwise concordance rates for MZ and DZ pairs were 24% and 4.8%, respectively. The tetrachoric correlations were 0.71 in MZ pairs and 0.31 in DZ pairs. The odds ratio (OR) was 71 (95% confidence interval [CI] 27-183) for MZ twins and 7.6 (95% CI 3.0-19) for DZ twins. In the structural equation models, genetic effects accounted for 70% (95% CI 0.33-0.83), shared environmental effects for 0% (95% CI 0-0.27), and nonshared environmental effects for 30% (95% CI 0.17-0.46) of the phenotypic variance among twins. CONCLUSION: These data provide robust epidemiologic evidence that heritability contributes to aneurysm formation. Concordances and correlations were higher in MZ compared with DZ twins, indicating genetic effects. There was a 24% probability that an MZ twin of a person with AAA will have the disease. The twin of an MZ twin with AAA had a risk of AAA that was 71 times that of the MZ twin of a person without AAA. A heritability of 70% of the total trait variance was estimated. The remaining variance was explai\u2026", "author" : [ { "dropping-particle" : "", "family" : "Wahlgren", "given" : "C M", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Larsson", "given" : "E", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Magnusson", "given" : "P K", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Hultgren", "given" : "R", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Swedenborg", "given" : "J", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "J Vasc Surg", "id" : "ITEM-1", "issue" : "1", "issued" : { "date-parts" : [ [ "2010" ] ] }, "note" : "Wahlgren, Carl Magnus\nLarsson, Emma\nMagnusson, Patrik K E\nHultgren, Rebecka\nSwedenborg, Jesper\neng\nTwin Study\n2009/11/27 06:00\nJ Vasc Surg. 2010 Jan;51(1):3-7; discussion 7. doi: 10.1016/j.jvs.2009.08.036. Epub 2009 Nov 24.", "page" : "3-7; discussion 7", "title" : "Genetic and environmental contributions to abdominal aortic aneurysm development in a twin population", "type" : "article-journal", "volume" : "51" }, "uris" : [ "http://www.mendeley.com/documents/?uuid=2ff7bda0-311a-4416-938a-e66834e76190" ] } ], "mendeley" : { "formattedCitation" : "28", "plainTextFormattedCitation" : "28", "previouslyFormattedCitation" : "28" }, "properties" : { }, "schema" : "https://github.com/citation-style-language/schema/raw/master/csl-citation.json" }28 and Denmark,ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1016/j.jvs.2016.05.051", "ISBN" : "1097-6809 (Electronic)\r0741-5214 (Linking)", "PMID" : "27763282", "author" : [ { "dropping-particle" : "", "family" : "Joergensen", "given" : "T M", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Christensen", "given" : "K", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Lindholt", "given" : "J S", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Larsen", "given" : "L A", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Green", "given" : "A", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Houlind", "given" : "K", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "J Vasc Surg", "id" : "ITEM-1", "issue" : "2", "issued" : { "date-parts" : [ [ "2016" ] ] }, "note" : "Joergensen, T M M\nChristensen, K\nLindholt, J S\nLarsen, L A\nGreen, A\nHoulind, K\neng\n2016/10/21 06:00\nJ Vasc Surg. 2016 Aug;64(2):537. doi: 10.1016/j.jvs.2016.05.051. Epub 2016 Jul 21.", "page" : "537", "title" : "High Heritability of Liability to Abdominal Aortic Aneurysms: A Population Based Twin Study", "type" : "article-journal", "volume" : "64" }, "uris" : [ "http://www.mendeley.com/documents/?uuid=97842a54-5080-469e-a034-2a977455a322" ] } ], "mendeley" : { "formattedCitation" : "29", "plainTextFormattedCitation" : "29", " p r e v i o u s l y F o r m a t t e d C i t a t i o n " : " < s u p > 2 9 < / s u p > " } , " p r o p e r t i e s " : { } , " s c h e m a " : " h t t p s : / / g i t h u b . c o m / c i t a t i o n - s t y l e - l a n g u a g e / s c h e m a / r a w / m a s t e r / c s l - c i t a t i o n . j s o n " } 2 9 t h e p h e n o t y p i c v a r i a n c e d e t e r m i n e d b y g e n e t i c s i s e s t i m a t e d t o b e 7 0 "8 0 % a n d n o n - s h a r e d e n v i r o n m e n t a l e f f e c t s ( s u c h a s s m o k i n g , i n f e c t i o n s , o r o c c u p a t i o n a l e x p o s u r e ) 2 0 "3 0 % .
H a v i n g a f i r s t - d e g r e e r e l a t i v e w i t h a n A A A i s a s i g n i f i c a n t r i s k f a c t o r ( O R : 1 . 9 6 ; 9 5 % C I : 1 . 6 8 "2 . 2 8 ) f o r t h e p e r s o n t o d e v e l o p a n A A A . A D D I N C S L _ C I T A T I O N { " c i t a t i o n Items" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1016/j.jvs.2008.08.012", "ISBN" : "1097-6809 (Electronic)\r0741-5214 (Linking)", "PMID" : "19028058", "abstract" : "BACKGROUND: Several studies have reported a familial clustering of abdominal aortic aneurysm (AAA) supporting that AAA is an inheritable disease, but few population-based studies can be found. Possible gender differences regarding hereditary patterns have been reported. OBJECTIVE: The aim of this study was to investigate the risk of developing an AAA for first-degree relatives of patients with AAA in Sweden and compare them with matched controls and their relatives. METHODS AND MATERIALS: All persons (3183) born after 1932, diagnosed with AAA between 2001 and 2005, and a random selection of 15,943 age-, gender-, and region-matched controls were included. First-degree relatives of cases and controls were identified via the Multigeneration Register. Family history of AAA for cases and controls was assessed by linking the relatives to the Hospital Discharge Register and Cause of Death Register. The data were analyzed by conditional logistic regression. RESULTS: The overall relative risk of AAA associated with family history compared to no family history was 1.9 (95% confidence interval [CI] 1.6-2.2). Comorbidities were more common among the cases than the controls (P < .0001) but the relative risks remained unchanged after adjustment for comorbidities. Stratification for absence or presence of comorbidities showed no significant difference between the two groups (P = .29). The relative risk of AAA for first-degree relatives was similar for women and men (P = .22 for gender differences), ie, the relative risk of AAA was not dependent on the gender of the index person. CONCLUSION: In this nationwide survey, the relative risk of developing AAA for first-degree relatives to persons diagnosed with AAA was approximately doubled compared to persons with no family history. Neither the gender of the index person nor the first-degree relative influenced the risk of AAA.", "author" : [ { "dropping-particle" : "", "family" : "Larsson", "given" : "E", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Granath", "given" : "F", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Swedenborg", "given" : "J", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Hultgren", "given" : "R", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "J Vasc Surg", "id" : "ITEM-1", "issue" : "1", "issued" : { "date-parts" : [ [ "2009" ] ] }, "note" : "Larsson, Emma\nGranath, Fredrik\nSwedenborg, Jesper\nHultgren, Rebecka\neng\nResearch Support, Non-U.S. Gov't\n2008/11/26 09:00\nJ Vasc Surg. 2009 Jan;49(1):47-50; discussion 51. doi: 10.1016/j.jvs.2008.08.012. Epub 2008 Nov 22.", "page" : "47-50; discussion 51", "title" : "A population-based case-control study of the familial risk of abdominal aortic aneurysm", "type" : "article-journal", "volume" : "49" }, "uris" : [ "http://www.mendeley.com/documents/?uuid=12634325-6ec2-40ed-b4fc-7255842ed295" ] } ], "mendeley" : { "formattedCitation" : "14", "plainTextFormattedCitation" : "14", "previouslyFormattedCitation" : "14" }, "properties" : { }, "schema" : "https://github.com/citation-style-language/schema/raw/master/csl-citation.json" }14 Positive family history for AAA has been suggested to have clinical implications, since familial AAA cases are reported to have increased growth rate ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1016/j.jvs.2014.07.007", "ISBN" : "1097-6809 (Electronic)\r0741-5214 (Linking)", "PMID" : "25175636", "abstract" : "OBJECTIVE: We aimed to investigate risk factors associated with more rapid growth of abdominal aortic aneurysms (AAA) <50 mm (small AAAs) in Japan. METHODS: We retrospectively investigated the clinical data of 374 patients with small AAAs (maximum diameter, /=45 mm was significantly greater than those with an initial diameter <45 mm (3.3 mm/y vs 2.0 mm/y, respectively; P = .007). The growth rate of AAAs was significantly greater in patients with hypertension than in those without (2.3 mm/y vs 1.7 mm/y, respectively; P = .006) and in patients with a family history of aortic aneurysm than in those without (4.2 mm/y vs 2.0 mm/y, respectively; P = .009). Logistic regression analysis revealed that a large initial diameter and family history of aortic aneurysm were independent predictors of accelerated growth rate of small AAAs in Japan. CONCLUSIONS: In the present study, a large initial diameter and family history of aortic aneurysm were independent risk factors for more rapid growth of small AAAs. Although few studies have reported similar findings thus far, family history of aortic aneurysm should be carefully considered during follow-up of patients with small AAAs.", "author" : [ { "dropping-particle" : "", "family" : "Akai", "given" : "A", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Watanabe", "given" : "Y", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Hoshina", "given" : "K", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Obitsu", "given" : "Y", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Deguchi", "given" : "J", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Sato", "given" : "O", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Shigematsu", "given" : "K", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Miyata", "given" : "T", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "J Vasc Surg", "id" : "ITEM-1", "issue" : "2", "issued" : { "date-parts" : [ [ "2015" ] ] }, "note" : "Akai, Atsushi\nWatanabe, Yoshiko\nHoshina, Katsuyuki\nObitsu, Yukio\nDeguchi, Juno\nSato, Osamu\nShigematsu, Kunihiro\nMiyata, Tetsuro\neng\nMulticenter Study\n2014/09/02 06:00\nJ Vasc Surg. 2015 Feb;61(2):287-90. doi: 10.1016/j.jvs.2014.07.007. Epub 2014 Aug 28.", "page" : "287-290", "title" : "Family history of aortic aneurysm is an independent risk factor for more rapid growth of small abdominal aortic aneurysms in Japan", "type" : "article-journal", "volume" : "61" }, "uris" : [ "http://www.mendeley.com/documents/?uuid=6dbfa9d4-7ff2-45ef-8a0a-62084882a54e" ] } ], "mendeley" : { "formattedCitation" : "30", "plainTextFormattedCitation" : "30", "previouslyFormattedCitation" : "30" }, "properties" : { }, "schema" : "https://github.com/citation-style-language/schema/raw/master/csl-citation.json" }30 or higher rupture risk,ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1016/j.avsg.2013.11.005", "ISBN" : "1615-5947 (Electronic)\r0890-5096 (Linking)", "PMID" : "24365082", "abstract" : "BACKGROUND: The objectives were to answer the following questions with the help of a well-characterized population in Liege, Belgium: 1) what percentage of patients with abdominal aortic aneurysm (AAA) have a positive family history for AAA? 2) what is the prevalence of AAAs among relatives of patients with AAA? and 3) do familial and sporadic AAA cases differ in clinical characteristics? METHODS: Patients with unrelated AAA diagnosed at the Cardiovascular Surgery Department, University Hospital of Liege, Belgium, between 1999 and 2012 were invited to the study. A detailed family history was obtained in interviews and recorded using Progeny software. We divided the 618 patients into 2 study groups: group I, 296 patients with AAA (268; 91% men) were followed up with computerized tomography combined with positron emission tomography; and group II, 322 patients with AAA (295; 92% men) whose families were invited to ultrasonographic screening. RESULTS: In the initial interview, 62 (10%) of the 618 patients with AAA reported a positive family history for AAA. Ultrasonographic screening identified 24 new AAAs among 186 relatives (>/=50 years) of 144 families yielding a prevalence of 13%. The highest prevalence (25%) was found among brothers. By combining the number of AAAs found by ultrasonographic screening with those diagnosed previously the observed lifetime prevalence of AAA was estimated to be 32% in brothers. The familial AAA cases were more likely to have a ruptured AAA than the sporadic cases (8% vs. 2.4%; P < 0.0001). CONCLUSIONS: The findings confirm previously found high prevalence of AAA among brothers, support genetic contribution to AAA pathogenesis, and provide rationale for targeted screening of relatives of patients with AAA.", "author" : [ { "dropping-particle" : "", "family" : "Sakalihasan", "given" : "N", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Defraigne", "given" : "J O", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Kerstenne", "given" : "M A", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Cheramy-Bien", "given" : "J P", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Smelser", "given" : "D T", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Tromp", "given" : "G", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Kuivaniemi", "given" : "H", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Ann Vasc Surg", "id" : "ITEM-1", "issue" : "4", "issued" : { "date-parts" : [ [ "2014" ] ] }, "note" : "Sakalihasan, Natzi\nDefraigne, Jean-Olivier\nKerstenne, Marie-Ange\nCheramy-Bien, Jean-Paul\nSmelser, Diane T\nTromp, Gerard\nKuivaniemi, Helena\neng\nR01 HL045996/HL/NHLBI NIH HHS/\nR01 HL064310/HL/NHLBI NIH HHS/\nComparative Study\nResearch Support, N.I.H., Extramural\nResearch Support, Non-U.S. Gov't\nNetherlands\n2013/12/25 06:00\nAnn Vasc Surg. 2014 May;28(4):787-97. doi: 10.1016/j.avsg.2013.11.005. Epub 2013 Dec 21.", "page" : "787-797", "title" : "Family members of patients with abdominal aortic aneurysms are at increased risk for aneurysms: analysis of 618 probands and their families from the Liege AAA Family Study", "type" : "article-journal", "volume" : "28" }, "uris" : [ "http://www.mendeley.com/documents/?uuid=2091f981-8e8c-4319-97f7-577911798f21" ] } ], "mendeley" : { "formattedCitation" : "15", "plainTextFormattedCitation" : "15", "previouslyFormattedCitation" : "15" }, "properties" : { }, "schema" : "https://github.com/citation-style-language/schema/raw/master/csl-citation.json" }15 than the sporadic ones, and possible also worse outcomes after endovascular aneurysm repair.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1016/j.jvs.2013.08.029", "ISBN" : "1097-6809 (Electronic)\r0741-5214 (Linking)", "PMID" : "24139982", "abstract" : "OBJECTIVE: A familial predisposition to abdominal aortic aneurysms (AAAs) is present in approximately one-fifth of patients. Nevertheless, the clinical implications of a positive family history are not known. We investigated the risk of aneurysm-related complications after endovascular aneurysm repair (EVAR) for patients with and without a positive family history of AAA. METHODS: Patients treated with EVAR for intact AAAs in the Erasmus University Medical Center between 2000 and 2012 were included in the study. Family history was obtained by written questionnaire. Familial AAA (fAAA) was defined as patients having at least one first-degree relative affected with aortic aneurysm. The remaining patients were considered sporadic AAA. Cardiovascular risk factors, aneurysm morphology (aneurysm neck, aneurysm sac, and iliac measurements), and follow-up were obtained prospectively. The primary end point was complications after EVAR, a composite of endoleaks, need for secondary interventions, aneurysm sac growth, acute limb ischemia, and postimplantation rupture. Secondary end points were specific components of the primary end point (presence of endoleak, need for secondary intervention, and aneurysm sac growth), aneurysm neck growth, and overall survival. Kaplan-Meier estimates for the primary end point were calculated and compared using log-rank (Mantel-Cox) test of equality. A Cox-regression model was used to calculate the independent risk of complications associated with fAAA. RESULTS: A total of 255 patients were included in the study (88.6% men; age 72 +/- 7 years, median follow-up 3.3 years; interquartile range, 2.2-6.1). A total of 51 patients (20.0%) were classified as fAAA. Patients with fAAA were younger (69 vs 72 years; P = .015) and were less likely to have ever smoked (58.8% vs 73.5%; P = .039). Preoperative aneurysm morphology was similar in both groups. Patients with fAAA had significantly more complications after EVAR (35.3% vs 19.1%; P = .013), with a twofold increased risk (adjusted hazard ratio, 2.1; 95% confidence interval, 1.2-3.7). Secondary interventions (39.2% vs 20.1%; P = .004) and aneurysm sac growth (20.8% vs 9.5%; P = .030) were the most important elements accounting for the difference. Furthermore, a trend toward more type I endoleaks during follow-up was observed (15.6% vs 7.4%; P = .063) and no difference in overall survival. CONCLUSIONS: The current study shows that patients with a familial form of AAA develop more aneurysm-rel\u2026", "author" : [ { "dropping-particle" : "", "family" : "Luijtgaarden", "given" : "K M", "non-dropping-particle" : "van de", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Bastos Goncalves", "given" : "F", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Hoeks", "given" : "S E", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Majoor-Krakauer", "given" : "D", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "V", "family" : "Rouwet", "given" : "E", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Stolker", "given" : "R J", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Verhagen", "given" : "H J", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "J Vasc Surg", "id" : "ITEM-1", "issue" : "2", "issued" : { "date-parts" : [ [ "2014" ] ] }, "note" : "van de Luijtgaarden, Koen M\nBastos Goncalves, Frederico\nHoeks, Sanne E\nMajoor-Krakauer, Danielle\nRouwet, Ellen V\nStolker, Robert J\nVerhagen, Hence J M\neng\nComparative Study\nResearch Support, Non-U.S. Gov't\n2013/10/22 06:00\nJ Vasc Surg. 2014 Feb;59(2):275-82. doi: 10.1016/j.jvs.2013.08.029. Epub 2013 Oct 17.", "page" : "275-282", "title" : "Familial abdominal aortic aneurysm is associated with more complications after endovascular aneurysm repair", "type" : "article-journal", "volume" : "59" }, "uris" : [ "http://www.mendeley.com/documents/?uuid=0208eda6-60ef-457e-be83-d6cda61d8f2c" ] }, { "id" : "ITEM-2", "itemData" : { "DOI" : "10.1016/j.jvs.2015.06.205", "ISBN" : "1097-6809 (Electronic)\r0741-5214 (Linking)", "PMID" : "26254452", "abstract" : "OBJECTIVE: A recent investigation has documented an increased risk of aneurysm-related complications after endovascular aneurysm repair (EVAR) of familial abdominal aortic aneurysms (fAAAs). We hypothesized that fAAA patients are not at increased risk for complications following open AAA repair or EVAR when compared with sporadic abdominal aortic aneurysm (spAAA) patients. To this end, we performed a single institution retrospective review. METHODS: Epidemiologic data were collected through the electronic medical record. Family history data were obtained from a questionnaire administered at the initial vascular surgery consultation. Major adverse events were defined as myocardial infarction, respiratory failure, renal failure, bowel ischemia, limb ischemia, multisystem organ failure, intracranial hemorrhage, paraplegia, hemorrhage, or death. Endoleaks were classified in accordance with the standardized reporting practices of the Society for Vascular Surgery. AAA-related complications were defined as the need for a secondary intervention due to endoleak, limb ischemia, or postimplantation rupture. RESULTS: A total of 392 patients with complete clinical data underwent elective AAA repair from 2004 to 2014. Of these 392 patients, 89 (23%) were classified as fAAA patients and 303 (77%) were classified as spAAA patients. With the exception of increased rates of chronic obstructive pulmonary disease (P = .0009) and pack-years smoked (P = .03) in spAAA patients, demographics did not differ. Sixty-two percent (n = 55) of fAAA patients and 68% (n = 205) of spAAA patients underwent EVAR (P = .30). fAAA patients did not incur any significant difference in major adverse events following open AAA repair (fAAA, 9% vs spAAA, 11%; P = .75). Additionally, fAAA patients did not incur any significant difference in major adverse events following EVAR (fAAA, 4% vs spAAA, 5%; P = .70). Patients with fAAA did have a significantly increased rate of endoleak (fAAA, 24% vs spAAA, 12%; P = .03) and secondary intervention following EVAR (fAAA, 21% vs spAAA, 12%; P = .04). CONCLUSIONS: The current study shows that patients with fAAA do not have increased perioperative morbidity following open or endovascular AAA repair. However, patients with fAAA do have an increased risk of endoleak and secondary intervention following EVAR. These findings suggest that EVAR and open AAA repair are both safe and effective for fAAA patients. The increased rate of endoleak and secondary intervention\u2026", "author" : [ { "dropping-particle" : "", "family" : "Ryer", "given" : "E J", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Garvin", "given" : "R P", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Thomas", "given" : "B", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Kuivaniemi", "given" : "H", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Franklin", "given" : "D P", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Elmore", "given" : "J R", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "J Vasc Surg", "id" : "ITEM-2", "issue" : "5", "issued" : { "date-parts" : [ [ "2015" ] ] }, "note" : "Ryer, Evan J\nGarvin, Robert P\nThomas, Biju\nKuivaniemi, Helena\nFranklin, David P\nElmore, James R\neng\nResearch Support, Non-U.S. Gov't\n2015/08/09 06:00\nJ Vasc Surg. 2015 Nov;62(5):1119-24.e9. doi: 10.1016/j.jvs.2015.06.205. Epub 2015 Aug 5.", "page" : "1119-24 e9", "title" : "Patients with familial abdominal aortic aneurysms are at increased risk for endoleak and secondary intervention following elective endovascular aneurysm repair", "type" : "article-journal", "volume" : "62" }, "uris" : [ "http://www.mendeley.com/documents/?uuid=ae095638-370c-44af-be4f-26888b18db8a" ] } ], "mendeley" : { "formattedCitation" : "31,32", "plainTextFormattedCitation" : "31,32", "previouslyFormattedCitation" : "31,32" }, "properties" : { }, "schema" : "https://github.com/citation-style-language/schema/raw/master/csl-citation.json" }31,32
Family-based genetic studies ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1161/01.CIR.0000127857.77161.A1", "ISBN" : "1524-4539 (Electronic)\r0009-7322 (Linking)", "PMID" : "15096456", "abstract" : "BACKGROUND: Abdominal aortic aneurysm (AAA) is a relatively common disease, with 1% to 2% of the population harboring aneurysms. Genetic risk factors are likely to contribute to the development of AAAs, although no such risk factors have been identified. METHODS AND RESULTS: We performed a whole-genome scan of AAA using affected-relative-pair (ARP) linkage analysis that includes covariates to allow for genetic heterogeneity. We found strong evidence of linkage (logarithm of odds [LOD] score=4.64) to a region near marker D19S433 at 51.88 centimorgans (cM) on chromosome 19 with 36 families (75 ARPs) when including sex and the number of affected first-degree relatives of the proband (N(aff)) as covariates. We then genotyped 83 additional families for the same markers and typed additional markers for all families and obtained a LOD score of 4.75 (P=0.00014) with sex, N(aff), and their interaction as covariates near marker D19S416 (58.69 cM). We also identified a region on chromosome 4 with a LOD score of 3.73 (P=0.0012) near marker D4S1644 using the same covariate model as for chromosome 19. CONCLUSIONS: Our results provide evidence for genetic heterogeneity and the presence of susceptibility loci for AAA on chromosomes 19q13 and 4q31.", "author" : [ { "dropping-particle" : "", "family" : "Shibamura", "given" : "H", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Olson", "given" : "J M", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Vlijmen-Van Keulen", "given" : "C", "non-dropping-particle" : "van", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Buxbaum", "given" : "S G", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Dudek", "given" : "D M", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Tromp", "given" : "G", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Ogata", "given" : "T", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Skunca", "given" : "M", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Sakalihasan", "given" : "N", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Pals", "given" : "G", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Limet", "given" : "R", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "MacKean", "given" : "G L", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Defawe", "given" : "O", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Verloes", "given" : "A", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Arthur", "given" : "C", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Lossing", "given" : "A G", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Burnett", "given" : "M", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Sueda", "given" : "T", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Kuivaniemi", "given" : "H", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Circulation", "id" : "ITEM-1", "issue" : "17", "issued" : { "date-parts" : [ [ "2004" ] ] }, "note" : "Shibamura, Hidenori\nOlson, Jane M\nvan Vlijmen-Van Keulen, Clarissa\nBuxbaum, Sarah G\nDudek, Doreen M\nTromp, Gerard\nOgata, Toru\nSkunca, Magdalena\nSakalihasan, Natzi\nPals, Gerard\nLimet, Raymond\nMacKean, Gerald L\nDefawe, Olivier\nVerloes, Alain\nArthur, Claudette\nLossing, Alan G\nBurnett, Marjorie\nSueda, Taijiro\nKuivaniemi, Helena\neng\nR01 HL064310/HL/NHLBI NIH HHS/\nHG01577/HG/NHGRI NIH HHS/\nHL64310/HL/NHLBI NIH HHS/\nRR03655/RR/NCRR NIH HHS/\nMulticenter Study\nResearch Support, U.S. Gov't, P.H.S.\n2004/04/21 05:00\nCirculation. 2004 May 4;109(17):2103-8. doi: 10.1161/01.CIR.0000127857.77161.A1. Epub 2004 Apr 19.", "page" : "2103-2108", "title" : "Genome scan for familial abdominal aortic aneurysm using sex and family history as covariates suggests genetic heterogeneity and identifies linkage to chromosome 19q13", "type" : "article-journal", "volume" : "109" }, "uris" : [ "http://www.mendeley.com/documents/?uuid=4176996f-cc3e-496c-82e7-a1d639e129f8" ] } ], "mendeley" : { "formattedCitation" : "33", "plainTextFormattedCitation" : "33", "previouslyFormattedCitation" : "33" }, "properties" : { }, "schema" : "https://github.com/citation-style-language/schema/raw/master/csl-citation.json" }33 are difficult to carry out for AAA, because it is a late-age-at-onset and deadly disease limiting the number of patients available for such studies. Genetic association studies using cases and controls have become the preferred method to identify genetic risk factors for AAA.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "S0890-5096(10)00424-3 [pii] 10.1016/j.avsg.2010.09.004", "ISBN" : "1615-5947 (Electronic) 0890-5096 (Linking)", "PMID" : "21146954", "abstract" : "Abdominal aortic aneurysm (AAA) is a multifactorial disease with a strong genetic component. Since the first candidate gene studies were published 20 years ago, approximately 100 genetic association studies using single nucleotide polymorphisms (SNPs) in biologically relevant genes have been reported on AAA. These studies investigated SNPs in genes of the extracellular matrix, the cardiovascular system, the immune system, and signaling pathways. Very few studies were large enough to draw firm conclusions and very few results could be replicated in another sample set. The more recent unbiased approaches are family-based DNA linkage studies and genome-wide genetic association studies, which have the potential of identifying the genetic basis for AAA, only when appropriately powered and well-characterized large AAA cohorts are used. SNPs associated with AAA have already been identified in these large multicenter studies. One significant association was of a variant in a gene called contactin-3, which is located on chromosome 3p12.3. However, two follow-up studies could not replicate this association. Two other SNPs, which are located on chromosome 9p21 and 9q33, were replicated in other samples. The two genes with the strongest supporting evidence of contribution to the genetic risk for AAA are the CDKN2BAS gene, also known as ANRIL, which encodes an antisense ribonucleic acid that regulates expression of the cyclin-dependent kinase inhibitors CDKN2A and CDKN2B, and DAB2IP, which encodes an inhibitor of cell growth and survival. Functional studies are now needed to establish the mechanisms by which these genes contribute toward AAA pathogenesis.", "author" : [ { "dropping-particle" : "", "family" : "Hinterseher", "given" : "I", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Tromp", "given" : "G", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Kuivaniemi", "given" : "H", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Ann Vasc Surg", "edition" : "2010/12/15", "id" : "ITEM-1", "issue" : "3", "issued" : { "date-parts" : [ [ "2011" ] ] }, "language" : "eng", "note" : "Hinterseher, Irene\nTromp, Gerard\nKuivaniemi, Helena\nR01 HL064310-08/HL/NHLBI NIH HHS/United States\nResearch Support, Non-U.S. Gov't\nReview\nUnited States\nAnnals of vascular surgery\nAnn Vasc Surg. 2011 Apr;25(3):388-412. doi: 10.1016/j.avsg.2010.09.004. Epub 2010 Dec 13.", "page" : "388-412", "title" : "Genes and abdominal aortic aneurysm", "type" : "article-journal", "volume" : "25" }, "uris" : [ "http://www.mendeley.com/documents/?uuid=39523e48-bf4a-40be-a38a-64994432fc5c" ] } ], "mendeley" : { "formattedCitation" : "34", "plainTextFormattedCitation" : "34", "previouslyFormattedCitation" : "34" }, "properties" : { }, "schema" : "https://github.com/citation-style-language/schema/raw/master/csl-citation.json" }34 The largest genome-wide association study (GWAS) for AAA included 4,972 AAA cases and 99,858 controls in the discovery phase, followed by genotyping in independent validation cohorts with 5,232 AAA cases and 7,908 controls.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1161/CIRCRESAHA.116.308765", "ISSN" : "15244571", "abstract" : "\u00a9 2016 The Authors. Rationale: Abdominal aortic aneurysm (AAA) is a complex disease with both genetic and environmental risk factors. Together, 6 previously identified risk loci only explain a small proportion of the heritability of AAA. Objective: To identify additional AAA risk loci using data from all available genome-wide association studies. Methods and Results: Through a meta-analysis of 6 genome-wide association study data sets and a validation study totaling 10 204 cases and 107 766 controls, we identified 4 new AAA risk loci: 1q32.3 (SMYD2), 13q12.11 (LINC00540), 20q13.12 (near PCIF1/MMP9/ZNF335), and 21q22.2 (ERG). In various database searches, we observed no new associations between the lead AAA single nucleotide polymorphisms and coronary artery disease, blood pressure, lipids, or diabetes mellitus. Network analyses identified ERG, IL6R, and LDLR as modifiers of MMP9, with a direct interaction between ERG and MMP9. 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"plainTextFormattedCitation" : "35", "previouslyFormattedCitation" : "35" }, "properties" : { }, "schema" : "https://github.com/citation-style-language/schema/raw/master/csl-citation.json" }35 The combined analyses with the discovery and validation sets identified 9 AAA risk loci [Au: table 1 lists SNPs, so replace loci with SNPs here?] (TABLE 1), 5 of which were previously known and 4 were new loci.
Despite the highly significant associations with these 9 genetic loci [Au: SNPs?] (TABLE 1), they explain only a small proportion of the heritability of AAA. Furthermore, the biology underlying these genetic associations still needs to be defined. One study used vascular smooth muscle cells (VSMCs) isolated from AAA patients and controls to assess DNA methylation in the genes found within the 9 associated loci.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1186/s13148-018-0460-9", "ISSN" : "1868-7075", "PMID" : "29507647", "abstract" : "Background Abdominal aortic aneurysm (AAA) is a deadly cardiovascular disease characterised by the gradual, irreversible dilation of the abdominal aorta. AAA is a complex genetic disease but little is known about the role of epigenetics. Our objective was to determine if global DNA methylation and CpG-specific methylation at known AAA risk loci is associated with AAA, and the functional effects of methylation changes. Results We assessed global methylation in peripheral blood mononuclear cell DNA from 92 individuals with AAA and 93 controls using enzyme-linked immunosorbent assays, identifying hyper-methylation in those with large AAA and a positive linear association with AAA diameter (P\u2009<\u20090.0001,R2\u2009=\u20090.3175).We then determined CpG methylation status of regulatory regions in genes located at AAA risk loci identified in genome-wide association studies, using bisulphite next-generation sequencing (NGS) in vascular smooth muscle cells (VSMCs) taken from aortic tissues of 44 individuals (24 AAAs and 20 controls). InIL6R, 2 CpGs were hyper-methylated (P\u2009=\u20090.0145); inERG, 13 CpGs were hyper-methylated (P\u2009=\u20090.0005); inSERPINB9, 6 CpGs were hypo-methylated (P\u2009=\u20090.0037) and 1 CpG was hyper-methylated (P\u2009=\u20090.0098); and inSMYD2, 4 CpGs were hypo-methylated (P\u2009=\u20090.0012).RT-qPCR was performed for each differentially methylated gene on mRNA from the same VSMCs and compared with methylation. This analysis revealed downregulation ofSMYD2andSERPINB9in AAA, and a direct linear relationship betweenSMYD2promoter methylation andSMYD2expression (P\u2009=\u20090.038). Furthermore, downregulation ofSMYD2at the site of aneurysm in the aortic wall was further corroborated in 6 of the same samples used for methylation and gene expression analysis with immunohistochemistry. Conclusions This study is the first to assess DNA methylation in VSMCs from individuals with AAA using NGS, and provides further evidence there is an epigenetic basis to AAA. Our study shows that methylation status of theSMYD2promoter may be linked with decreasedSMYD2expression in disease pathobiology. In support of our work, downregulatedSMYD2has previously been associated with adverse cardiovascular physiology and inflammation, which are both hallmarks of AAA. The identification of such adverse epigenetic modifications could potentially contribute towards the development of epigenetic treatment strategies in the future.", "author" : [ { "dropping-particle" : "", "family" : "Toghill", "given" : "Bradley J.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Saratzis", "given" : "Athanasios", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Freeman", "given" : "Peter J.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Sylvius", "given" : "Nicolas", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Bown", "given" : "Matthew J.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Bown", "given" : "Matthew J", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Clinical Epigenetics", "id" : "ITEM-1", "issue" : "1", "issued" : { "date-parts" : [ [ "2018", "12", "2" ] ] }, "page" : "29", "title" : "SMYD2 promoter DNA methylation is associated with abdominal aortic aneurysm (AAA) and SMYD2 expression in vascular smooth muscle cells", "type" : "article-journal", "volume" : "10" }, "uris" : [ "http://www.mendeley.com/documents/?uuid=65c64362-94ca-3a84-8bcc-257eb3e1f1ea" ] } ], "mendeley" : { "formattedCitation" : "36", "plainTextFormattedCitation" : "36", "previouslyFormattedCitation" : "36" }, "properties" : { }, "schema" : "https://github.com/citation-style-language/schema/raw/master/csl-citation.json" }36 Altered DNA methylation levels were found in 4 genes(ERG, IL6R, SERPINB9 and SMYD2) [Au: can you comment on what function(s) these genes are involved?] suggesting that epigenetic mechanisms such as DNA methylation are implicated in AAA development. The proteins ERG and SMYG2 are transcriptional regulators controlling the expression of other genes, IL6R is an inflammatory molecule, and SERPINB9 is a protease inhibitor. Additional functional studies will help in dissecting the pathobiology leading to AAA development, growth and rupture. Future studies need to take into account these different stages of the AAA disease, since it is likely that the molecular mechanisms and genetic factors differ in the initiation, growth and rupture of AAA .ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "ISBN" : "0214-0934 (Print)\r0214-0934 (Linking)", "PMID" : "18560612", "abstract" : "Abdominal aortic aneurysm (AAA) is a complex multifactorial disease with life-threatening implications. Aneurysms typically have no signs or symptoms, and rupture of AAA has a high mortality rate. Multiple environmental and genetic risk factors are involved in aneurysm formation and progression making it a complicated disease to study. Little is understood about the mechanisms in disease initiation, thus there are currently no therapeutic approaches to prevent AAA, leaving patients with surgery as their only option. Ongoing research into the genetic components of AAA using a candidate gene approach has been overall unsuccessful. A more promising approach to study complex diseases involves genome-wide techniques such as DNA linkage analysis, genetic association studies and microarray expression profiling. Furthermore, studies involving inhibition of AAA progression, rather than formation, have a potentially promising outcome. Targeting biological pathways in AAA pathogenesis may benefit patients by slowing the growth and possibly preventing the rupture of AAA. Critical pathways involved in AAA pathogenesis include immunological processes, such as T-cell and natural killer cell pathways, oxidative stress, depletion of vascular smooth muscle cells through the process of apoptosis and the destruction of the extracellular matrix by matrix metalloproteinases.", "author" : [ { "dropping-particle" : "", "family" : "Boddy", "given" : "A M", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Lenk", "given" : "G M", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Lillvis", "given" : "J H", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Nischan", "given" : "J", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Kyo", "given" : "Y", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Kuivaniemi", "given" : "H", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Drug News Perspect", "edition" : "2008/06/19", "id" : "ITEM-1", "issue" : "3", "issued" : { "date-parts" : [ [ "2008" ] ] }, "language" : "eng", "note" : "Boddy, Amy M\nLenk, Guy M\nLillvis, John H\nNischan, Jennifer\nKyo, Yoshiki\nKuivaniemi, Helena\nAG030900/AG/NIA NIH HHS/United States\nHL045996/HL/NHLBI NIH HHS/United States\nHL06410/HL/NHLBI NIH HHS/United States\nResearch Support, N.I.H., Extramural\nResearch Support, Non-U.S. Gov't\nReview\nSpain\nDrug news & perspectives\nDrug News Perspect. 2008 Apr;21(3):142-8.", "page" : "142-148", "title" : "Basic research studies to understand aneurysm disease", "type" : "article-journal", "volume" : "21" }, "uris" : [ "http://www.mendeley.com/documents/?uuid=51d97875-eb88-4d9d-8217-17ee9837a7bd" ] } ], "mendeley" : { "formattedCitation" : "37", "plainTextFormattedCitation" : "37", "previouslyFormattedCitation" : "37" }, "properties" : { }, "schema" : "https://github.com/citation-style-language/schema/raw/master/csl-citation.json" }37
Another important genetic finding on AAA includes a study that demonstrated that longer telomere length was associated with reduced risk (OR: 0.63; 95%C I : 0 . 4 9 "0 . 8 1 ) f o r A A A , b u t i n c r e a s e d r i s k f o r c a n c e r . A D D I N C S L _ C I T A T I O N { " c i t a t i o n I t e m s " : [ { " i d " : " I T E M - 1 " , " i t e m D a t a " : { " D O I " : " 1 0 . 1 0 0 1 / j a m a o n c o l . 2 0 1 6 . 5 9 4 5 " , " I S B N " : " 2 3 7 4 - 2 4 4 5 ( E l e c t r o n i c ) \ r 2 3 7 4 - 2 4 3 7 ( L i n k i n g ) " , " P M I D " : " 2 8 2 4 1 2 0 8 " , " a b s t r a c t " : "Importance: The causal direction and magnitude of the association between telomere length and incidence of cancer and non-neoplastic diseases is uncertain owing to the susceptibility of observational studies to confounding and reverse causation. Objective: To conduct a Mendelian randomization study, using germline genetic variants as instrumental variables, to appraise the causal relevance of telomere length for risk of cancer and non-neoplastic diseases. Data Sources: Genomewide association studies (GWAS) published up to January 15, 2015. Study Selection: GWAS of noncommunicable diseases that assayed germline genetic variation and did not select cohort or control participants on the basis of preexisting diseases. Of 163 GWAS of noncommunicable diseases identified, summary data from 103 were available. Data Extraction and Synthesis: Summary association statistics for single nucleotide polymorphisms (SNPs) that are strongly associated with telomere length in the general population. Main Outcomes and Measures: Odds ratios (ORs) and 95% confidence intervals (CIs) for disease per standard deviation (SD) higher telomere length due to germline genetic variation. Results: Summary data were available for 35 cancers and 48 non-neoplastic diseases, corresponding to 420081 cases (median cases, 2526 per disease) and 1093105 controls (median, 6789 per disease). Increased telomere length due to germline genetic variation was generally associated with increased risk for site-specific cancers. The strongest associations (ORs [95% CIs] per 1-SD change in genetically increased telomere length) were observed for glioma, 5.27 (3.15-8.81); serous low-malignant-potential ovarian cancer, 4.35 (2.39-7.94); lung adenocarcinoma, 3.19 (2.40-4.22); neuroblastoma, 2.98 (1.92-4.62); bladder cancer, 2.19 (1.32-3.66); melanoma, 1.87 (1.55-2.26); testicular cancer, 1.76 (1.02-3.04); kidney cancer, 1.55 (1.08-2.23); and endometrial cancer, 1.31 (1.07-1.61). Associations were stronger for rarer cancers and at tissue sites with lower rates of stem cell division. There was generally little evidence of association between genetically increased telomere length and risk of psychiatric, autoimmune, inflammatory, diabetic, and other non-neoplastic diseases, except for coronary heart disease (OR, 0.78 [95% CI, 0.67-0.90]), abdominal aortic aneurysm (OR, 0.63 [95% CI, 0.49-0.81]), celiac disease (OR, 0.42 [95% CI, 0.28-0.61]) and interstitial lung disease (OR, 0.09 [95% CI, 0.05-0.15]). 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Finally, AAAs appear to differ genetically from thoracic aortic aneurysms and dissections [Au: abbreviation deleted for readability, as it is only used a handful of times] and do not usually co-occur in the same family.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1016/j.jvs.2012.04.056", "ISBN" : "1097-6809 (Electronic)\r0741-5214 (Linking)", "PMID" : "22727846", "abstract" : "OBJECTIVE: Although the association of thoracic aortic aneurysm (TAA) with abdominal aortic aneurysm (AAA) is known, the exact magnitude of the association has not been described. Our goal was to quantify the incidence of TAA in patients with an AAA and assess predictive factors for its diagnosis. METHODS: This was a retrospective review of all patients diagnosed with AAA from 2000-2008. The subsequent development or diagnosis of a TAA was noted and the association between AAA and TAA described. RESULTS: A total of 2196 patients with an AAA were reviewed. 1082 (49.3%) had a chest computed tomography (CT) during follow-up. 117 patients (10.8%) had a synchronous and 136 (12.6%) a metachronous TAA. Mean time to diagnosis was 2.3 years. Mean diameter was 4.7 +/- 1.4 cm for AAA, and 4.7 +/- 1.0 for TAA. Indications for the chest CT were variable. Most common were AAA (15%), pulmonary embolus (14%), and lung cancer (11%). Only 38% of AAAs and 14% of TAAs were repaired during the study period. Of all patients with known AAA who were found to have a TAA, 61/253 (24%) underwent repair, had a rupture, or had a TAA >5.5 cm. At a mean follow-up of 43.6 months, there were 79 deaths (7%): 7 AAA-related and 13 from TAA ruptures. Predictors of TAA diagnosis by logistic regression include African American race (odds ratio [OR] = 1.8; P = .02), family history of TAA (OR = 7.6; P = .04), hypertension (OR = 1.7; P = .006), and obesity (OR = 1.7; P = .006). Diabetes, infrarenal AAA location, and smoking have a negative association. CONCLUSIONS: TAAs are relatively common in patients with AAA. Routine or targeted screening with a chest CT at the time of AAA diagnosis may be indicated.", "author" : [ { "dropping-particle" : "", "family" : "Chaer", "given" : "R A", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Vasoncelos", "given" : "R", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Marone", "given" : "L K", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Al-Khoury", "given" : "G", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Rhee", "given" : "R Y", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Cho", "given" : "J S", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Makaroun", "given" : "M S", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "J Vasc Surg", "id" : "ITEM-1", "issue" : "5", "issued" : { "date-parts" : [ [ "2012" ] ] }, "note" : "Chaer, Rabih A\nVasoncelos, Rogerio\nMarone, Luke K\nAl-Khoury, George\nRhee, Robert Y\nCho, Jae S\nMakaroun, Michel S\neng\n2012/06/26 06:00\nJ Vasc Surg. 2012 Nov;56(5):1261-5. doi: 10.1016/j.jvs.2012.04.056. Epub 2012 Jun 22.", "page" : "1261-1265", "title" : "Synchronous and metachronous thoracic aneurysms in patients with abdominal aortic aneurysms", "type" : "article-journal", "volume" : "56" }, "uris" : [ "http://www.mendeley.com/documents/?uuid=ad49550b-28d1-47ec-ac43-6c385fac3e00" ] } ], "mendeley" : { "formattedCitation" : "39", "plainTextFormattedCitation" : "39", "previouslyFormattedCitation" : "39" }, "properties" : { }, "schema" : "https://github.com/citation-style-language/schema/raw/master/csl-citation.json" }39 The overlap between the genetic loci currently known for thoracic aortic aneurysms and dissections and AAA is limited,ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1586/14779072.2015.1074861", "ISBN" : "1744-8344 (Electronic)\r1477-9072 (Linking)", "PMID" : "26308600", "abstract" : "An aortic aneurysm is a dilatation in which the aortic diameter is >/=3.0 cm. If left untreated, the aortic wall continues to weaken and becomes unable to withstand the forces of the luminal blood pressure resulting in progressive dilatation and rupture, a catastrophic event associated with a mortality of 50-80%. Smoking and positive family history are important risk factors for the development of abdominal aortic aneurysms (AAA). Several genetic risk factors have also been identified. On the histological level, visible hallmarks of AAA pathogenesis include inflammation, smooth muscle cell apoptosis, extracellular matrix degradation and oxidative stress. We expect that large genetic, genomic, epigenetic, proteomic and metabolomic studies will be undertaken by international consortia to identify additional risk factors and biomarkers, and to enhance our understanding of the pathobiology of AAA. Collaboration between different research groups will be important in overcoming the challenges to develop pharmacological treatments for AAA.", "author" : [ { "dropping-particle" : "", "family" : "Kuivaniemi", "given" : "H", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Ryer", "given" : "E J", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Elmore", "given" : "J R", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Tromp", "given" : "G", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Expert Rev Cardiovasc Ther", "id" : "ITEM-1", "issue" : "9", "issued" : { "date-parts" : [ [ "2015" ] ] }, "note" : "Kuivaniemi, Helena\nRyer, Evan J\nElmore, James R\nTromp, Gerard\neng\nR01 HL045996/HL/NHLBI NIH HHS/\nR01 HL064310/HL/NHLBI NIH HHS/\nU01 HG006382/HG/NHGRI NIH HHS/\nResearch Support, N.I.H., Extramural\nResearch Support, Non-U.S. Gov't\nReview\nEngland\n2015/08/27 06:00\nExpert Rev Cardiovasc Ther. 2015;13(9):975-87. doi: 10.1586/14779072.2015.1074861.", "page" : "975-987", "title" : "Understanding the pathogenesis of abdominal aortic aneurysms", "type" : "article-journal", "volume" : "13" }, "uris" : [ "http://www.mendeley.com/documents/?uuid=0fdc273f-6316-44e9-8b0c-7e9223d30d8b" ] }, { "id" : "ITEM-2", "itemData" : { "DOI" : "10.12945/j.aorta.2017.17.003", "ISBN" : "2325-4637 (Print)\r2325-4637 (Linking)", "PMID" : "28868310", "abstract" : "Thoracic aortic aneurysm (TAA) is a lethal disease, with a natural history of enlarging progressively until dissection or rupture occurs. Since the discovery almost 20 years ago that ascending TAAs are highly familial, our understanding of the genetics of thoracic aortic aneurysm and dissection (TAAD) has increased exponentially. At least 29 genes have been shown to be associated with the development of TAAD, the majority of which encode proteins involved in the extracellular matrix, smooth muscle cell contraction or metabolism, or the transforming growth factor-beta signaling pathway. Almost one-quarter of TAAD patients have a mutation in one of these genes. In this review, we provide a summary of TAAD-associated genes, associated clinical features of the vasculature, and implications for surgical treatment of TAAD. With the widespread use of next-generation sequencing and development of novel functional assays, the future of the genetics of TAAD is bright, as both novel TAAD genes and variants within the genes will continue to be identified.", "author" : [ { "dropping-particle" : "", "family" : "Brownstein", "given" : "A J", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Ziganshin", "given" : "B A", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Kuivaniemi", "given" : "H", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Body", "given" : "S C", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Bale", "given" : "A E", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Elefteriades", "given" : "J A", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Aorta (Stamford)", "id" : "ITEM-2", "issue" : "1", "issued" : { "date-parts" : [ [ "2017" ] ] }, "note" : "Brownstein, Adam J\nZiganshin, Bulat A\nKuivaniemi, Helena\nBody, Simon C\nBale, Allen E\nElefteriades, John A\neng\nReview\nStamford, Conn.\n2017/09/05 06:00\nAorta (Stamford). 2017 Feb 1;5(1):11-20. doi: 10.12945/j.aorta.2017.17.003. eCollection 2017 Feb.", "page" : "11-20", "title" : "Genes Associated with Thoracic Aortic Aneurysm and Dissection: An Update and Clinical Implications", "type" : "article-journal", "volume" : "5" }, "uris" : [ "http://www.mendeley.com/documents/?uuid=132e8e58-03e1-4f9f-a20c-4b18a7304d6f" ] } ], "mendeley" : { "formattedCitation" : "40,41", "plainTextFormattedCitation" : "40,41", "previouslyFormattedCitation" : "40,41" }, "properties" : { }, "schema" : "https://github.com/citation-style-language/schema/raw/master/csl-citation.json" }40,41 [Au: how many SNPs out of 9?] suggesting that pathobiology in the 2 aneurysmal diseases is distinct. For example, none of the 9 AAA loci have been associated with thoracic aortic aneurysms and dissections, but interestingly, one of them (rs10757274) has been associated with intracranial aneurysms.
Growth and Rupture risk of AAA
Since AAA is commonly asymptomatic, in the absence of screening programmes, most patients with AAA remain undiagnosed. The mean growth rate is 2.5 mm/year in medium sized AAAs (39-49 mm), and is faster in current smokers, and slower in patients with diabetes mellitus.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.7326/0003-4819-159-12-201312170-00007", "ISBN" : "1539-3704 (Electronic)\r0003-4819 (Linking)", "PMID" : "24490266", "abstract" : "BACKGROUND: Doxycycline inhibits formation and progression of abdominal aortic aneurysms (AAAs) in preclinical models of the disease, but it is unclear whether and how this observation translates to humans. OBJECTIVE: To test whether doxycycline inhibits AAA progression in humans. DESIGN: Randomized, placebo-controlled, double-blind trial. (Dutch Trial Registry: NTR 1345) SETTING: 14 Dutch hospitals. PATIENTS: 286 patients with small AAAs between October 2008 and June 2011. INTERVENTION: Daily dose of 100 mg of doxycycline (n = 144) or placebo (n = 142) for 18 months. MEASUREMENTS: The primary outcome measure was aneurysm growth at 18 months, as estimated by repeated single-observer ultrasonography. Secondary outcomes included growth at 6 and 12 months and the need for elective surgery. RESULTS: Mean aneurysm diameter (approximately 43 mm) and other baseline characteristics were similar in both groups. Doxycycline treatment was associated with increased aneurysm growth (4.1 mm in the doxycycline group vs. 3.3 mm in the placebo group at 18 months; difference, 0.8 mm [95% CI, 0.1 to 1.4 mm]; P = 0.016 mm). Twenty-one patients receiving doxycycline and 22 patients receiving placebo had elective surgical repair (Kaplan-Meier estimates were 16.1% for those receiving doxycycline and 16.5% for those receiving placebo; difference, -0.4% [CI, -9.3% to 8.5%]; P = 0.83). Time to repair was similar in the groups (P = 0.92). LIMITATIONS: This study focuses on patients with small AAAs. As such, whether the data can be extrapolated to larger AAAs (>55 mm) is unclear. The high number of elective repairs (n = 43) was unanticipated. Moreover, the study did not follow patients who withdrew because of an adverse effect. CONCLUSION: This trial found that 18 months of doxycycline therapy did not reduce aneurysm growth and did not influence the need for AAA repair or time to repair. PRIMARY FUNDING SOURCE: The Netherlands Organisation for Health Research and Development, and the NutsOhra Fund.", "author" : [ { "dropping-particle" : "", "family" : "Meijer", "given" : "C A", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Stijnen", "given" : "T", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Wasser", "given" : "M N", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Hamming", "given" : "J F", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Bockel", "given" : "J H", "non-dropping-particle" : "van", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Lindeman", "given" : "J H", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Pharmaceutical Aneurysm Stabilisation Trial Study", "given" : "Group", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Ann Intern Med", "id" : "ITEM-1", "issue" : "12", "issued" : { "date-parts" : [ [ "2013" ] ] }, "note" : "Meijer, C Arnoud\nStijnen, Theo\nWasser, Martin N J M\nHamming, Jaap F\nvan Bockel, J Hajo\nLindeman, Jan H N\neng\nMulticenter Study\nRandomized Controlled Trial\nResearch Support, Non-U.S. Gov't\n2014/02/04 06:00\nAnn Intern Med. 2013 Dec 17;159(12):815-23. doi: 10.7326/0003-4819-159-12-201312170-00007.", "page" : "815-823", "title" : "Doxycycline for stabilization of abdominal aortic aneurysms: a randomized trial", "type" : "article-journal", "volume" : "159" }, "uris" : [ "http://www.mendeley.com/documents/?uuid=520ab43e-cf39-4b18-9ebd-a60e034d5504" ] }, { "id" : "ITEM-2", "itemData" : { "DOI" : "10.1002/bjs.9824", "ISBN" : "1365-2168 (Electronic)\r0007-1323 (Linking)", "PMID" : "25963302", "abstract" : "BACKGROUND: Abdominal aortic aneurysm (AAA) is thought to develop as a result of inflammatory processes in the aortic wall. In particular, mast cells are believed to play a central role. The AORTA trial was undertaken to investigate whether the mast cell inhibitor, pemirolast, could retard the growth of medium-sized AAAs. In preclinical and clinical trials, pemirolast has been shown to inhibit antigen-induced allergic reactions. METHODS: Inclusion criteria for the trial were patients with an AAA of 39-49 mm in diameter on ultrasound imaging. Among exclusion criteria were previous aortic surgery, diabetes mellitus, and severe concomitant disease with a life expectancy of less than 2 years. Included patients were treated with 10, 25 or 40 mg pemirolast, or matching placebo for 52 weeks. The primary endpoint was change in aortic diameter as measured from leading edge adventitia at the anterior wall to leading edge adventitia at the posterior wall in systole. All ultrasound scans were read in a central imaging laboratory. RESULTS: Some 326 patients (mean age 70.8 years; 88.0 per cent men) were included in the trial. The overall mean growth rate was 2.42 mm during the 12-month study. There was no statistically significant difference in growth between patients receiving placebo and those in the three dose groups of pemirolast. Similarly, there were no differences in adverse events. CONCLUSION: Treatment with pemirolast did not retard the growth of medium-sized AAAs. REGISTRATION NUMBER: NCT01354184 (https://www.clinicaltrials.gov).", "author" : [ { "dropping-particle" : "", "family" : "Sillesen", "given" : "H", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Eldrup", "given" : "N", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Hultgren", "given" : "R", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Lindeman", "given" : "J", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Bredahl", "given" : "K", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Thompson", "given" : "M", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Wanhainen", "given" : "A", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Wingren", "given" : "U", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Swedenborg", "given" : "J", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Investigators", "given" : "Aorta Trial", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Br J Surg", "id" : "ITEM-2", "issue" : "8", "issued" : { "date-parts" : [ [ "2015" ] ] }, "note" : "Sillesen, H\nEldrup, N\nHultgren, R\nLindeman, J\nBredahl, K\nThompson, M\nWanhainen, A\nWingren, U\nSwedenborg, J\neng\nMulticenter Study\nRandomized Controlled Trial\nResearch Support, Non-U.S. Gov't\nEngland\n2015/05/13 06:00\nBr J Surg. 2015 Jul;102(8):894-901. doi: 10.1002/bjs.9824. Epub 2015 May 12.", "page" : "894-901", "title" : "Randomized clinical trial of mast cell inhibition in patients with a medium-sized abdominal aortic aneurysm", "type" : "article-journal", "volume" : "102" }, "uris" : [ "http://www.mendeley.com/documents/?uuid=91cfe1d6-3027-4ef1-acb3-ca381740c3a1" ] }, { "id" : "ITEM-3", "itemData" : { "DOI" : "10.1002/bjs.8707", "ISBN" : "1365-2168 (Electronic)\r0007-1323 (Linking)", "PMID" : "22389113", "abstract" : "BACKGROUND: Surveillance is a common management strategy for small abdominal aortic aneurysm (AAA) (3.0-5.4 cm in diameter). Individual characteristics, other than diameter, may influence aneurysm growth or rupture rates. METHODS: Individual data were collated from 15 475 people under follow-up for a small aneurysm in 18 studies. The influence of co-variables (including demographics, medical and drug history) on aneurysm growth and rupture rates (analysed using longitudinal random-effects modelling and survival analysis with adjustment for aneurysm diameter) were summarized in an individual patient meta-analysis. RESULTS: The mean aneurysm growth rate of 2.21 mm/year was independent of age and sex. Growth rate was increased in smokers (by 0.35 mm/year) and decreased in patients with diabetes (by 0.51 mm/year). Mean arterial pressure had no effect and antihypertensive or other cardioprotective medications had only small, non-significant effects on aneurysm growth, consistent with the observation that calendar year of enrollment was not associated with growth rate. Rupture rates were almost fourfold higher in women than men (P < 0.001), were double in current smokers (P = 0.001) and increased with higher blood pressure (P = 0.001). CONCLUSION: Follow-up schedules for individuals with a small AAA may need to consider diabetes and smoking, in addition to aneurysm diameter. The differing risk factors for growth and rupture suggest that a lower threshold for surgical intervention in women may be justified. No single drug used for cardiovascular risk reduction had a major effect on the growth or rupture of small aneurysms.", "author" : [ { "dropping-particle" : "", "family" : "Sweeting", "given" : "M J", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Thompson", "given" : "S G", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Brown", "given" : "L C", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Powell", "given" : "J T", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "collaborators", "given" : "Rescan", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Br J Surg", "id" : "ITEM-3", "issue" : "5", "issued" : { "date-parts" : [ [ "2012" ] ] }, "note" : "Sweeting, M J\nThompson, S G\nBrown, L C\nPowell, J T\neng\n09/91/39/Department of Health/United Kingdom\nHTA/09/91/39/Department of Health/United Kingdom\nRG/08/014/24067/British Heart Foundation/United Kingdom\nMC_U105232027/Medical Research Council/United Kingdom\nMC_U105260792/Medical Research Council/United Kingdom\nMeta-Analysis\nResearch Support, Non-U.S. Gov't\nReview\nEngland\n2012/03/06 06:00\nBr J Surg. 2012 May;99(5):655-65. doi: 10.1002/bjs.8707. Epub 2012 Mar 5.", "page" : "655-665", "title" : "Meta-analysis of individual patient data to examine factors affecting growth and rupture of small abdominal aortic aneurysms", "type" : "article-journal", "volume" : "99" }, "uris" : [ "http://www.mendeley.com/documents/?uuid=79e835fb-08ec-489c-b3dd-52f59ba49dc8" ] } ], "mendeley" : { "formattedCitation" : "19,44,45", "plainTextFormattedCitation" : "19,44,45", "previouslyFormattedCitation" : "19,44,45" }, "properties" : { }, "schema" : "https://github.com/citation-style-language/schema/raw/master/csl-citation.json" }19,44,45 Other factors that have been inconsistently reported to be associated with increased growth are hypertension, female sex and COPD.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1002/bjs.8707", "ISBN" : "1365-2168 (Electronic)\r0007-1323 (Linking)", "PMID" : "22389113", "abstract" : "BACKGROUND: Surveillance is a common management strategy for small abdominal aortic aneurysm (AAA) (3.0-5.4 cm in diameter). Individual characteristics, other than diameter, may influence aneurysm growth or rupture rates. METHODS: Individual data were collated from 15 475 people under follow-up for a small aneurysm in 18 studies. The influence of co-variables (including demographics, medical and drug history) on aneurysm growth and rupture rates (analysed using longitudinal random-effects modelling and survival analysis with adjustment for aneurysm diameter) were summarized in an individual patient meta-analysis. RESULTS: The mean aneurysm growth rate of 2.21 mm/year was independent of age and sex. Growth rate was increased in smokers (by 0.35 mm/year) and decreased in patients with diabetes (by 0.51 mm/year). Mean arterial pressure had no effect and antihypertensive or other cardioprotective medications had only small, non-significant effects on aneurysm growth, consistent with the observation that calendar year of enrollment was not associated with growth rate. Rupture rates were almost fourfold higher in women than men (P < 0.001), were double in current smokers (P = 0.001) and increased with higher blood pressure (P = 0.001). CONCLUSION: Follow-up schedules for individuals with a small AAA may need to consider diabetes and smoking, in addition to aneurysm diameter. The differing risk factors for growth and rupture suggest that a lower threshold for surgical intervention in women may be justified. No single drug used for cardiovascular risk reduction had a major effect on the growth or rupture of small aneurysms.", "author" : [ { "dropping-particle" : "", "family" : "Sweeting", "given" : "M J", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Thompson", "given" : "S G", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Brown", "given" : "L C", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Powell", "given" : "J T", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "collaborators", "given" : "Rescan", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Br J Surg", "id" : "ITEM-1", "issue" : "5", "issued" : { "date-parts" : [ [ "2012" ] ] }, "note" : "Sweeting, M J\nThompson, S G\nBrown, L C\nPowell, J T\neng\n09/91/39/Department of Health/United Kingdom\nHTA/09/91/39/Department of Health/United Kingdom\nRG/08/014/24067/British Heart Foundation/United Kingdom\nMC_U105232027/Medical Research Council/United Kingdom\nMC_U105260792/Medical Research Council/United Kingdom\nMeta-Analysis\nResearch Support, Non-U.S. Gov't\nReview\nEngland\n2012/03/06 06:00\nBr J Surg. 2012 May;99(5):655-65. doi: 10.1002/bjs.8707. Epub 2012 Mar 5.", "page" : "655-665", "title" : "Meta-analysis of individual patient data to examine factors affecting growth and rupture of small abdominal aortic aneurysms", "type" : "article-journal", "volume" : "99" }, "uris" : [ "http://www.mendeley.com/documents/?uuid=79e835fb-08ec-489c-b3dd-52f59ba49dc8" ] }, { "id" : "ITEM-2", "itemData" : { "DOI" : "10.1161/01.CIR.0000133279.07468.9F 01.CIR.0000133279.07468.9F [pii]", "ISBN" : "1524-4539 (Electronic) 0009-7322 (Linking)", "PMID" : "15210603", "abstract" : "BACKGROUND: Intervention to reduce abdominal aortic aneurysm (AAA) expansion and optimization of screening intervals would improve current surveillance programs. The aim of this study was to characterize AAA growth in a national cohort of patients with AAA both overall and by cardiovascular risk factors. METHODS AND RESULTS: In this study, 1743 patients were monitored for changes in AAA diameter by ultrasonography over a mean follow-up of 1.9 years. Mean initial AAA diameter and growth rate were 43 mm (range 28 to 85 mm) and 2.6 mm/year (95% range, -1.0 to 6.1 mm/year), respectively. Baseline diameter was strongly associated with growth, suggesting that AAA growth accelerates as the aneurysm enlarges. AAA growth rate was lower in those with low ankle/brachial pressure index and diabetes but higher for current smokers (all P<0.001). No other factor (including lipids and blood pressure) was associated with AAA growth. Intervals of 36, 24, 12, and 3 months for aneurysms of 35, 40, 45, and 50 mm, respectively, would restrict the probability of breaching the 55-mm limit at rescreening to below 1%. CONCLUSIONS: Annual, or less frequent, surveillance intervals are safe for all AAAs < or =45 mm in diameter. Smoking increases AAA growth, but atherosclerosis plays a minor role.", "author" : [ { "dropping-particle" : "", "family" : "Brady", "given" : "A R", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Thompson", "given" : "S G", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Fowkes", "given" : "F G", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Greenhalgh", "given" : "R M", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Powell", "given" : "J T", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Circulation", "edition" : "2004/06/24", "id" : "ITEM-2", "issue" : "1", "issued" : { "date-parts" : [ [ "2004" ] ] }, "language" : "eng", "note" : "Brady, Anthony R\nThompson, Simon G\nFowkes, F Gerald R\nGreenhalgh, Roger M\nPowell, Janet T\nUK Small Aneurysm Trial Participants\nResearch Support, Non-U.S. Gov't\nUnited States\nCirculation\nCirculation. 2004 Jul 6;110(1):16-21. Epub 2004 Jun 21.", "page" : "16-21", "title" : "Abdominal aortic aneurysm expansion: risk factors and time intervals for surveillance", "type" : "article-journal", "volume" : "110" }, "uris" : [ "http://www.mendeley.com/documents/?uuid=6ee74b62-f1f6-4276-ae2a-838f7efa35b3" ] }, { "id" : "ITEM-3", "itemData" : { "ISBN" : "0003-4932 (Print) 0003-4932 (Linking)", "PMID" : "10493476", "abstract" : "OBJECTIVE: To investigate risk factors associated with aneurysm rupture using patients randomized into the U.K. Small Aneurysm Trial (n = 1090) or monitored for aneurysm growth in the associated study (n = 1167). SUMMARY BACKGROUND DATA: The U.K. Small Aneurysm Trial has shown that ultrasound surveillance is a safe management option for patients with small abdominal aortic aneurysms (4.0 to 5.5 cm in diameter), with an annual rupture rate of 1%. METHODS: In the cohort of 2257 patients (79% male), aged 59 to 77 years, 103 instances of abdominal aortic aneurysm rupture were identified during the 7-year period of follow-up (1991-1998). Almost all patients (98%) had initial aneurysm diameters in the range of 3 to 6 cm, and the majority of ruptures (76%) occurred in patients with aneurysms > or =5 cm in diameter. Kaplan-Meier survival and Cox regression analysis were used to identify baseline risk factors associated with aneurysm rupture. RESULTS: After 3 years, the annual rate of aneurysm rupture was 2.2% (95% confidence interval 1.7 to 2.8). The risk of rupture was independently and significantly associated with female sex (p < 0.001), larger initial aneurysm diameter (p < 0.001), lower FEV1 (p = 0.004), current smoking (p = 0.01), and higher mean blood pressure (p = 0.01). Age, body mass index, serum cholesterol concentration, and ankle/brachial pressure index were not associated with an increased risk of aneurysm rupture. CONCLUSIONS: Within this cohort of patients, women had a threefold higher risk of aneurysm rupture than men. Effective control of blood pressure and cessation of smoking are likely to diminish the risk of rupture.", "author" : [ { "dropping-particle" : "", "family" : "Brown", "given" : "L C", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Powell", "given" : "J T", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Ann Surg", "edition" : "1999/09/24", "id" : "ITEM-3", "issue" : "3", "issued" : { "date-parts" : [ [ "1999" ] ] }, "language" : "eng", "note" : "Brown, L C\nPowell, J T\nClinical Trial\nRandomized Controlled Trial\nResearch Support, Non-U.S. Gov't\nUnited states\nAnnals of surgery\nAnn Surg. 1999 Sep;230(3):289-96; discussion 296-7.", "page" : "287-289", "title" : "Risk factors for aneurysm rupture in patients kept under ultrasound surveillance. UK Small Aneurysm Trial Participants", "type" : "article-journal", "volume" : "230" }, "uris" : [ "http://www.mendeley.com/documents/?uuid=489ae34b-76c1-4c97-871a-0d100e5b5ba1" ] } ], "mendeley" : { "formattedCitation" : "19,47,48", "plainTextFormattedCitation" : "19,47,48", "previouslyFormattedCitation" : "19,47,48" }, "properties" : { }, "schema" : "https://github.com/citation-style-language/schema/raw/master/csl-citation.json" }19,47,48 No pharmaceutical agent that could slow AAA growth has been found, despite many attempts. Individuals with an undiagnosed AAA are at risk for AAA rupture, which can lead to sudden death from massive intra-abdominal bleeding.
Factors that influence the risk for rupture have been difficult to identify. One of the larger meta-analyses in the field confirmed the higher rupture risk in women, the increased risk in current smokers, and those with untreated hypertension.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1002/bjs.8707", "ISBN" : "1365-2168 (Electronic)\r0007-1323 (Linking)", "PMID" : "22389113", "abstract" : "BACKGROUND: Surveillance is a common management strategy for small abdominal aortic aneurysm (AAA) (3.0-5.4 cm in diameter). Individual characteristics, other than diameter, may influence aneurysm growth or rupture rates. METHODS: Individual data were collated from 15 475 people under follow-up for a small aneurysm in 18 studies. The influence of co-variables (including demographics, medical and drug history) on aneurysm growth and rupture rates (analysed using longitudinal random-effects modelling and survival analysis with adjustment for aneurysm diameter) were summarized in an individual patient meta-analysis. RESULTS: The mean aneurysm growth rate of 2.21 mm/year was independent of age and sex. Growth rate was increased in smokers (by 0.35 mm/year) and decreased in patients with diabetes (by 0.51 mm/year). Mean arterial pressure had no effect and antihypertensive or other cardioprotective medications had only small, non-significant effects on aneurysm growth, consistent with the observation that calendar year of enrollment was not associated with growth rate. Rupture rates were almost fourfold higher in women than men (P < 0.001), were double in current smokers (P = 0.001) and increased with higher blood pressure (P = 0.001). CONCLUSION: Follow-up schedules for individuals with a small AAA may need to consider diabetes and smoking, in addition to aneurysm diameter. The differing risk factors for growth and rupture suggest that a lower threshold for surgical intervention in women may be justified. No single drug used for cardiovascular risk reduction had a major effect on the growth or rupture of small aneurysms.", "author" : [ { "dropping-particle" : "", "family" : "Sweeting", "given" : "M J", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Thompson", "given" : "S G", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Brown", "given" : "L C", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Powell", "given" : "J T", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "collaborators", "given" : "Rescan", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Br J Surg", "id" : "ITEM-1", "issue" : "5", "issued" : { "date-parts" : [ [ "2012" ] ] }, "note" : "Sweeting, M J\nThompson, S G\nBrown, L C\nPowell, J T\neng\n09/91/39/Department of Health/United Kingdom\nHTA/09/91/39/Department of Health/United Kingdom\nRG/08/014/24067/British Heart Foundation/United Kingdom\nMC_U105232027/Medical Research Council/United Kingdom\nMC_U105260792/Medical Research Council/United Kingdom\nMeta-Analysis\nResearch Support, Non-U.S. Gov't\nReview\nEngland\n2012/03/06 06:00\nBr J Surg. 2012 May;99(5):655-65. doi: 10.1002/bjs.8707. Epub 2012 Mar 5.", "page" : "655-665", "title" : "Meta-analysis of individual patient data to examine factors affecting growth and rupture of small abdominal aortic aneurysms", "type" : "article-journal", "volume" : "99" }, "uris" : [ "http://www.mendeley.com/documents/?uuid=79e835fb-08ec-489c-b3dd-52f59ba49dc8" ] }, { "id" : "ITEM-2", "itemData" : { "DOI" : "10.1016/j.maturitas.2017.12.012", "ISBN" : "1873-4111 (Electronic)\r0378-5122 (Linking)", "PMID" : "29452784", "abstract" : "OBJECTIVE: Abdominal aortic aneurysm (AAA) predominantly affects an elderly male population. Even so, AAA appears more detrimental in women, who experience a higher risk of aneurysm rupture and a worse outcome after surgery than men. Why women are privileged from yet are worse off once affected has been attributed to an effect of sex hormones. This review summarizes the knowledge of sex differences in AAA and addresses the changes in the aneurysm wall from a gender perspective. METHOD: Standard reporting guidelines set by the PRISMA Group were followed to identify studies examining AAA from a gender perspective. Relevant reports were identified using two electronic databases: PubMed and Web of Science. The systematic search was performed in two stages: firstly, using the terms AAA and gender/sex/women; and secondly, adding the terms \"elastin\", \"collagen\" and \"vascular smooth muscle cells\", in order to filter the search for studies relevant to our focus on the aneurysm wall. CONCLUSION: Current studies support the theory that sex has an effect on aneurysm formation, yet are inconclusive about whether or not aneurysm formation is dependent on female/male sex hormones or a lack thereof. The studies in women are scarce and out of those most reports primarily address other end-points, which limit their ability to illuminate an effect of sex on aneurysm formation. The complexity of the human menstrual cycle and menopausal transition are difficult to mimic in animal models, which limit their applicability to AAA formation in humans.", "author" : [ { "dropping-particle" : "", "family" : "Villard", "given" : "C", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Hultgren", "given" : "R", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Maturitas", "id" : "ITEM-2", "issued" : { "date-parts" : [ [ "2018" ] ] }, "note" : "Villard, Christina\nHultgren, Rebecka\neng\nReview\nIreland\n2018/02/18 06:00\nMaturitas. 2018 Mar;109:63-69. doi: 10.1016/j.maturitas.2017.12.012. Epub 2017 Dec 13.", "page" : "63-69", "title" : "Abdominal aortic aneurysm: Sex differences", "type" : "article-journal", "volume" : "109" }, "uris" : [ "http://www.mendeley.com/documents/?uuid=b6e93bfa-89d3-4bd9-9b29-82005cbbae98" ] }, { "id" : "ITEM-3", "itemData" : { "ISBN" : "0003-4932 (Print) 0003-4932 (Linking)", "PMID" : "10493476", "abstract" : "OBJECTIVE: To investigate risk factors associated with aneurysm rupture using patients randomized into the U.K. Small Aneurysm Trial (n = 1090) or monitored for aneurysm growth in the associated study (n = 1167). SUMMARY BACKGROUND DATA: The U.K. Small Aneurysm Trial has shown that ultrasound surveillance is a safe management option for patients with small abdominal aortic aneurysms (4.0 to 5.5 cm in diameter), with an annual rupture rate of 1%. METHODS: In the cohort of 2257 patients (79% male), aged 59 to 77 years, 103 instances of abdominal aortic aneurysm rupture were identified during the 7-year period of follow-up (1991-1998). Almost all patients (98%) had initial aneurysm diameters in the range of 3 to 6 cm, and the majority of ruptures (76%) occurred in patients with aneurysms > or =5 cm in diameter. Kaplan-Meier survival and Cox regression analysis were used to identify baseline risk factors associated with aneurysm rupture. RESULTS: After 3 years, the annual rate of aneurysm rupture was 2.2% (95% confidence interval 1.7 to 2.8). The risk of rupture was independently and significantly associated with female sex (p < 0.001), larger initial aneurysm diameter (p < 0.001), lower FEV1 (p = 0.004), current smoking (p = 0.01), and higher mean blood pressure (p = 0.01). Age, body mass index, serum cholesterol concentration, and ankle/brachial pressure index were not associated with an increased risk of aneurysm rupture. CONCLUSIONS: Within this cohort of patients, women had a threefold higher risk of aneurysm rupture than men. Effective control of blood pressure and cessation of smoking are likely to diminish the risk of rupture.", "author" : [ { "dropping-particle" : "", "family" : "Brown", "given" : "L C", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Powell", "given" : "J T", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Ann Surg", "edition" : "1999/09/24", "id" : "ITEM-3", "issue" : "3", "issued" : { "date-parts" : [ [ "1999" ] ] }, "language" : "eng", "note" : "Brown, L C\nPowell, J T\nClinical Trial\nRandomized Controlled Trial\nResearch Support, Non-U.S. Gov't\nUnited states\nAnnals of surgery\nAnn Surg. 1999 Sep;230(3):289-96; discussion 296-7.", "page" : "287-289", "title" : "Risk factors for aneurysm rupture in patients kept under ultrasound surveillance. UK Small Aneurysm Trial Participants", "type" : "article-journal", "volume" : "230" }, "uris" : [ "http://www.mendeley.com/documents/?uuid=489ae34b-76c1-4c97-871a-0d100e5b5ba1" ] } ], "mendeley" : { "formattedCitation" : "19,22,48", "plainTextFormattedCitation" : "19,22,48", "previouslyFormattedCitation" : "19,22,48" }, "properties" : { }, "schema" : "https://github.com/citation-style-language/schema/raw/master/csl-citation.json" }19,22,48 The risk of AAA rupture is associated with aneurysm diameter a prediction that has some weaknesses, since in a few patients the AAA will rupture at less than 55 mm diameter even when surveilled at a vascular clinic. Precision medicine options to identify more patient-specific rupture risk predictions are therefore under investigation, using factors such as aneurysm volume, aortic size index (the association between aortic width and body surface area), family history of AAA, presence of diabetes and biomarkers.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1016/j.jvs.2016.10.074", "ISBN" : "1097-6809 (Electronic)\r0741-5214 (Linking)", "PMID" : "28342508", "abstract" : "OBJECTIVE: Finite element analysis (FEA) has been suggested to be superior to maximal diameter measurements in predicting rupture of abdominal aortic aneurysms (AAAs). Our objective was to investigate to what extent previously described rupture risk factors were associated with FEA-estimated rupture risk. METHODS: One hundred forty-six patients with an asymptomatic AAA of a 40- to 60-mm diameter were retrospectively identified and consecutively included. The patients' computed tomography angiograms were analyzed by FEA without (neutral) and with (specific) input of patient-specific mean arterial pressure (MAP), gender, family history, and age. The maximal wall stress/wall strength ratio was described as a rupture risk equivalent diameter (RRED), which translated this ratio into an average aneurysm diameter of corresponding rupture risk. RESULTS: In multivariate linear regression, RREDneutral increased with female gender (3.7 mm; 95% confidence interval [CI], 0.13-7.3) and correlated with patient height (0.27 mm/cm; 95% CI, 0.11-0.43) and body surface area (BSA, 16 mm/m(2); 95% CI, 8.3-24) and inversely with body mass index (BMI, -0.40 mm/kg m(-2); 95% CI, -0.75 to -0.054) in a wall stress-dependent manner. Wall stress-adjusted RREDneutral was raised if the patient was currently smoking (1.1 mm; 95% CI, 0.21-1.9). Age, MAP, family history, and patient weight were unrelated to RREDneutral. In specific FEA, RREDspecific increased with female gender, MAP, family history positive for AAA, height, and BSA, whereas it was inversely related to BMI. All results were independent of aneurysm diameter. Peak wall stress and RRED correlated with aneurysm diameter and lumen volume. CONCLUSIONS: Female gender, current smoking, increased patient height and BSA, and low BMI were found to increase the mechanical rupture risk of AAAs. Previously described rupture risk factors may in part be explained by patient characteristic-dependent variations in aneurysm biomechanics.", "author" : [ { "dropping-particle" : "", "family" : "Lindquist Liljeqvist", "given" : "M", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Hultgren", "given" : "R", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Siika", "given" : "A", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Gasser", "given" : "T C", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Roy", "given" : "J", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "J Vasc Surg", "id" : "ITEM-1", "issue" : "4", "issued" : { "date-parts" : [ [ "2017" ] ] }, "note" : "Lindquist Liljeqvist, Moritz\nHultgren, Rebecka\nSiika, Antti\nGasser, T Christian\nRoy, Joy\neng\n2017/03/28 06:00\nJ Vasc Surg. 2017 Apr;65(4):1014-1021.e4. doi: 10.1016/j.jvs.2016.10.074.", "page" : "1014-1021 e4", "title" : "Gender, smoking, body size, and aneurysm geometry influence the biomechanical rupture risk of abdominal aortic aneurysms as estimated by finite element analysis", "type" : "article-journal", "volume" : "65" }, "uris" : [ "http://www.mendeley.com/documents/?uuid=53d90a21-aa21-435a-a962-6a09127b1ac4" ] }, { "id" : "ITEM-2", "itemData" : { "DOI" : "10.1016/S0140-6736(17)30639-6", "ISBN" : "1474-547X (Electronic)\r0140-6736 (Linking)", "PMID" : "28455148", "abstract" : "BACKGROUND: Prognosis for women with abdominal aortic aneurysm might be worse than the prognosis for men. We aimed to systematically quantify the differences in outcomes between men and women being assessed for repair of intact abdominal aortic aneurysm using data from study periods after the year 2000. METHODS: In these systematic reviews and meta-analysis, we identified studies (randomised, cohort, or cross-sectional) by searching MEDLINE, Embase, CENTRAL, and grey literature published between Jan 1, 2005, and Sept 2, 2016, for two systematic reviews and Jan 1, 2009, and Sept 2, 2016, for one systematic review. Studies were included if they were of both men and women, with data presented for each sex separately, with abdominal aortic aneurysms being assessed for aneurysm repair by either endovascular repair (EVAR) or open repair. We conducted three reviews based on whether studies reported the proportion morphologically suitable (within manufacturers' instructions for use) for EVAR (EVAR suitability review), non-intervention rates (non-intervention review), and 30-day mortality (operative mortality review) after intact aneurysm repair. Studies had to include at least 20 women (for the EVAR suitability review), 20 women (for the non-intervention review), and 50 women (for the operative mortality review). Studies were excluded if they were review articles, editorials, letters, or case reports. For the operative review, studies were also excluded if they only provided hazard ratios or only reported in-hospital mortality. We assessed the quality of the studies using the Newcastle-Ottawa scoring system, and contacted authors for the provision of additional data if needed. We combined results across studies by random-effects meta-analysis. This study is registered with PROSPERO, number CRD42016043227. FINDINGS: Five studies assessed the morphological eligibility for EVAR (1507 men, 400 women). The overall pooled proportion of women eligible (34%) for EVAR was lower than it was in men (54%; odds ratio [OR] 0.44, 95% CI 0.32-0.62). Four single-centre studies reported non-intervention rates (1365 men, 247 women). The overall pooled non-intervention rates were higher in women (34%) than men (19%; OR 2.27, 95% CI 1.21-4.23). The review of 30-day mortality included nine studies (52 018 men, 11 076 women). The overall pooled estimate for EVAR was higher in women (2.3%) than in men (1.4%; OR 1.67, 95% CI 1.38-2.04). The overall estimate for open repair also was hig\u2026", "author" : [ { "dropping-particle" : "", "family" : "Ulug", "given" : "P", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Sweeting", "given" : "M J", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Allmen", "given" : "R S", "non-dropping-particle" : "von", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Thompson", "given" : "S G", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Powell", "given" : "J T", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "collaborators", "given" : "Swan", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Lancet", "id" : "ITEM-2", "issue" : "10088", "issued" : { "date-parts" : [ [ "2017" ] ] }, "note" : "Ulug, Pinar\nSweeting, Michael J\nvon Allmen, Regula S\nThompson, Simon G\nPowell, Janet T\neng\nEngland\nLondon, England\n2017/04/30 06:00\nLancet. 2017 Jun 24;389(10088):2482-2491. doi: 10.1016/S0140-6736(17)30639-6. Epub 2017 Apr 25.", "page" : "2482-2491", "title" : "Morphological suitability for endovascular repair, non-intervention rates, and operative mortality in women and men assessed for intact abdominal aortic aneurysm repair: systematic reviews with meta-analysis", "type" : "article-journal", "volume" : "389" }, "uris" : [ "http://www.mendeley.com/documents/?uuid=e8dd9a70-7375-4b41-b0d8-c7ccb66c4806" ] }, { "id" : "ITEM-3", "itemData" : { "DOI" : "10.1161/ATVBAHA.116.308147", "ISBN" : "1524-4636 (Electronic)\r1079-5642 (Linking)", "PMID" : "27834688", "abstract" : "OBJECTIVE: Abdominal aortic aneurysm (AAA) is an important vascular disease in older adults, but data on lifetime risk of AAA are sparse. We examined lifetime risk of AAA in a community-based cohort and prospectively assessed the association between midlife cardiovascular risk factors and AAAs. APPROACH AND RESULTS: In ARIC study (Atherosclerosis Risk in Communities), 15 792 participants were recruited at visit 1 in 1987 to 1989 and followed up through 2013. Longitudinal smoking status was defined using smoking behavior ascertained from visit 1 (1987-1989) to visit 4 (1996-1998). We followed up participants for incident, clinical AAAs using hospital discharge diagnoses, Medicare outpatient diagnoses, or death certificates through 2011 and identified 590 incident AAAs. An abdominal ultrasound was conducted in 2011 to 2013 in 5911 surviving participants, and 75 asymptomatic AAAs were identified. We estimated the lifetime risk of AAA from the index age 45 years through 85 years of age. At age 45, the lifetime risk for AAA was 5.6% (95% confidence interval, 4.8-6.1) and was higher in men (8.2%) and current smokers (10.5%). Smokers who quit smoking between visit 1 and visit 4 had a 29% lower AAA lifetime risk compared with continuous smokers but had a higher risk than pre-visit 1 quitters. The lifetime risk of rupture or medical intervention was 1.6% (95% confidence interval, 1.2-1.8). Smoking, white race, male sex, greater height, and greater low-density lipoprotein or total cholesterol were associated with an increased risk of clinical AAA and asymptomatic AAA. CONCLUSIONS: At least 1 in 9 middle-aged current smokers developed AAA in their lifetime. Smoking cessation reduced the lifetime risk of AAA.", "author" : [ { "dropping-particle" : "", "family" : "Tang", "given" : "W", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Yao", "given" : "L", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Roetker", "given" : "N S", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Alonso", "given" : "A", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Lutsey", "given" : "P L", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Steenson", "given" : "C C", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Lederle", "given" : "F A", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Hunter", "given" : "D W", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Bengtson", "given" : "L G", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Guan", "given" : "W", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Missov", "given" : "E", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Folsom", "given" : "A R", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Arterioscler Thromb Vasc Biol", "id" : "ITEM-3", "issue" : "12", "issued" : { "date-parts" : [ [ "2016" ] ] }, "note" : "Tang, Weihong\nYao, Lu\nRoetker, Nicholas S\nAlonso, Alvaro\nLutsey, Pamela L\nSteenson, Carol C\nLederle, Frank A\nHunter, David W\nBengtson, Lindsay G S\nGuan, Weihua\nMissov, Emil\nFolsom, Aaron R\neng\nHHSN268201100012C/HL/NHLBI NIH HHS/\nHHSN268201100009I/HL/NHLBI NIH HHS/\nHHSN268201100010C/HL/NHLBI NIH HHS/\nHHSN268201100008C/HL/NHLBI NIH HHS/\nHHSN268201100005G/HL/NHLBI NIH HHS/\nHHSN268201100008I/HL/NHLBI NIH HHS/\nHHSN268201100007C/HL/NHLBI NIH HHS/\nHHSN268201100011I/HL/NHLBI NIH HHS/\nHHSN268201100011C/HL/NHLBI NIH HHS/\nHHSN268201100006C/HL/NHLBI NIH HHS/\nHHSN268201100005I/HL/NHLBI NIH HHS/\nHHSN268201100009C/HL/NHLBI NIH HHS/\nHHSN268201100005C/HL/NHLBI NIH HHS/\nHHSN268201100007I/HL/NHLBI NIH HHS/\nR01 HL103695/HL/NHLBI NIH HHS/\nMulticenter Study\n2016/11/12 06:00\nArterioscler Thromb Vasc Biol. 2016 Dec;36(12):2468-2477. doi: 10.1161/ATVBAHA.116.308147. Epub 2016 Nov 10.", "page" : "2468-2477", "title" : "Lifetime Risk and Risk Factors for Abdominal Aortic Aneurysm in a 24-Year Prospective Study: The ARIC Study (Atherosclerosis Risk in Communities)", "type" : "article-journal", "volume" : "36" }, "uris" : [ "http://www.mendeley.com/documents/?uuid=3151d0ae-db80-4a12-9a4a-e43bda1a32cc" ] }, { "id" : "ITEM-4", "itemData" : { "DOI" : "10.1016/j.atherosclerosis.2017.03.010", "ISBN" : "1879-1484 (Electronic)\r0021-9150 (Linking)", "PMID" : "28347473", "abstract" : "BACKGROUND AND AIMS: There is increasing interest in identifying novel methods for abdominal aortic aneurysm (AAA) diagnosis. Non-coding RNA molecules such as microRNAs (miRNAs) are stable within the circulation and may serve as biomarkers for AAA. This systematic review aimed to identify miRNAs associated with a diagnosis of human AAA based on currently published original research. METHODS: A systematic search of the MEDLINE and EMBASE databases identified studies assessing miRNA expression in abdominal aortic tissue or circulating blood from human AAA cases compared to non-aneurysmal controls. Data from included studies were extracted to assess methods and results after independent quality assessment by two reviewers. RESULTS: 15 studies were included in this review. 11 studies obtained aortic tissue samples from 195 AAA cases and 104 controls with normal aortas. Nine studies obtained circulating blood samples from 526 AAA cases and 441 controls. miR-21 was differentially expressed in AAA tissue in five separate studies, with four studies reporting upregulation and one reporting downregulation. Seven other miRNAs were differentially expressed in AAA tissue in two separate studies. 15 circulating miRNAs were differentially expressed in two or more separate studies. miR-155 and miR-29b were the only miRNAs differentially expressed in two separate tissue- and blood-based studies. 11 studies offered mechanistic explanations of the role of miRNAs in AAA pathology through exploration of gene targets. Three studies assessed the diagnostic potential of circulating miRNAs with receiver operating characteristic curves. Only one study assessed the prognostic potential of circulating miRNAs in predicting AAA growth. CONCLUSIONS: Several miRNAs have been found to be associated with human AAA. Their utility as AAA biomarkers requires further investigation.", "author" : [ { "dropping-particle" : "", "family" : "Iyer", "given" : "V", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Rowbotham", "given" : "S", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Biros", "given" : "E", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Bingley", "given" : "J", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Golledge", "given" : "J", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Atherosclerosis", "id" : "ITEM-4", "issued" : { "date-parts" : [ [ "2017" ] ] }, "note" : "Iyer, Vikram\nRowbotham, Sophie\nBiros, Erik\nBingley, John\nGolledge, Jonathan\neng\nReview\nIreland\n2017/03/30 06:00\nAtherosclerosis. 2017 Jun;261:78-89. doi: 10.1016/j.atherosclerosis.2017.03.010. Epub 2017 Mar 8.", "page" : "78-89", "title" : "A systematic review investigating the association of microRNAs with human abdominal aortic aneurysms", "type" : "article-journal", "volume" : "261" }, "uris" : [ "http://www.mendeley.com/documents/?uuid=bdd0f235-9090-49d1-a694-3b8007bcca2d" ] }, { "id" : "ITEM-5", "itemData" : { "DOI" : "10.1016/j.jvs.2015.11.051", "ISBN" : "1097-6809 (Electronic)\r0741-5214 (Linking)", "PMID" : "27106248", "abstract" : "BACKGROUND: The diagnosis and management of abdominal aortic aneurysms (AAAs) currently relies on the aortic maximal diameter, which grows in an unpredictable manner. Infrarenal aortic volume has recently become clinically feasible to measure, and an estimate of biomechanical rupture risk derived from finite element analysis, the peak wall rupture index (PWRI), has been shown to predict AAA rupture. Our objective was to ascertain how well volume growth correlates with baseline volume and increasing PWRI, compared with the maximal diameter. METHODS: We retrospectively identified 41 AAA patients (nine women, 32 men) at our institution who had undergone two computed tomography angiographies with an interval of 8 to 17 months. Digital three-dimensional reproductions of the aneurysms were segmented from the 82 computed tomography angiographies. AAA diameter, volume, and PWRI were measured and calculated with finite element analysis software. Growth rates of diameter and volume were related to baseline diameter and volume as well as to change rates of PWRI. Significant growth was defined as growth exceeding our interobserver 95% limits of agreement. RESULTS: Diameter growth rate did not correlate with baseline diameter (r = 0.15, 95% confidence interval [CI], -0.17 to 0.45), but volume growth rate correlated with baseline volume (r = 0.56; 95% CI, 0.30-0.75). The correlation between baseline volume and volume growth rate was stronger than the correlation between baseline diameter and diameter growth rate (95% CI, 0.086-0.71). Increasing PWRI correlated with volume growth rate (r = 0.70; 95% CI, 0.40-0.87) but not with diameter growth rate (r = 0.044; 95% CI, -0.44 to 0.51), and the difference between the correlation coefficients was significant (95% CI, 0.11-1.16). CONCLUSIONS: Volume better predicts aneurysm growth rate and correlates stronger with increasing estimated biomechanical rupture risk compared with diameter. Our results support the notion of monitoring all three dimensions of an AAA.", "author" : [ { "dropping-particle" : "", "family" : "Lindquist Liljeqvist", "given" : "M", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Hultgren", "given" : "R", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Gasser", "given" : "T C", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Roy", "given" : "J", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "J Vasc Surg", "id" : "ITEM-5", "issue" : "6", "issued" : { "date-parts" : [ [ "2016" ] ] }, "note" : "Lindquist Liljeqvist, Moritz\nHultgren, Rebecka\nGasser, T Christian\nRoy, Joy\neng\nComparative Study\n2016/04/24 06:00\nJ Vasc Surg. 2016 Jun;63(6):1434-1442.e3. doi: 10.1016/j.jvs.2015.11.051. Epub 2016 Apr 19.", "page" : "1434-1442 e3", "title" : "Volume growth of abdominal aortic aneurysms correlates with baseline volume and increasing finite element analysis-derived rupture risk", "type" : "article-journal", "volume" : "63" }, "uris" : [ "http://www.mendeley.com/documents/?uuid=edacd3a5-391d-41a0-8b6f-659e37f75bfd" ] }, { "id" : "ITEM-6", "itemData" : { "DOI" : "0741-5214(91)90249-T [pii]", "ISBN" : "0741-5214 (Print)\r0741-5214 (Linking)", "PMID" : "1920652", "abstract" : "Expansion rate and incidence of rupture of abdominal aortic aneurysms in relation to their size is a source of debate. We studied 114 patients (out of a cohort of 752 consecutive patients admitted with abdominal aortic aneurysms) who were denied any immediate operation because of patient's refusal, high surgical risk, or small transverse diameter as assessed by CT scanning and ultrasonography. All patients not operated on underwent from two to six repeated examinations during an average follow-up period of 26.8 months (range, 3 to 132). Forty-seven patients (41.2%) were subsequently operated on electively because of marked increase of transverse diameter of the aneurysm (n = 44) or for other reasons (n = 3), with a death rate of 0%. Eighteen other patients underwent emergency operation for leaking or ruptured aneurysms, and there were five deaths. The incidence of rupture was clearly related to the final diameter value, rising from 0% in aneurysms less than 40 mm to 22% in large size aneurysms (greater than or equal to 50 mm). Among the 49 patients not operated on, one died of rupture before operation and five of causes unrelated to the disease. Using individual serial measurements, we determined the linear expansion rate of the aneurysm, which proved to be related to initial diameter values: 5.3 mm/year for diameters less than 40 mm (n = 49), 6.9 mm/year in the 40 to 49 mm group (n = 41), and 7.4 mm/year for diameters of 50 mm or more (n = 24).(ABSTRACT TRUNCATED AT 250 WORDS)", "author" : [ { "dropping-particle" : "", "family" : "Limet", "given" : "R", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Sakalihassan", "given" : "N", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Albert", "given" : "A", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "J Vasc Surg", "edition" : "1991/10/01", "id" : "ITEM-6", "issue" : "4", "issued" : { "date-parts" : [ [ "1991" ] ] }, "language" : "eng", "note" : "Limet, R\nSakalihassan, N\nAlbert, A\nUnited states\nJournal of vascular surgery\nJ Vasc Surg. 1991 Oct;14(4):540-8.", "page" : "540-548", "title" : "Determination of the expansion rate and incidence of rupture of abdominal aortic aneurysms", "type" : "article-journal", "volume" : "14" }, "uris" : [ "http://www.mendeley.com/documents/?uuid=2aa4a7aa-3fbf-4214-8a98-f917b026b5c7" ] }, { "id" : "ITEM-7", "itemData" : { "DOI" : "S0741-5214(96)70153-2 [pii]", "ISBN" : "0741-5214 (Print) 0741-5214 (Linking)", "PMID" : "8691515", "abstract" : "PURPOSE: This consistent observation of a reduction of the elastin concentration in abdominal aortic aneurysms (AAAs) has led us to investigate in AAA specimens two metalloproteinases that display elastase activity, MMP2 (gelatinase A/72kDa) and MMP9 (gelatinase B/92 kDa). METHODS: Samples of full-thickness aortic wall, adherent thrombus, and serum were collected in 10 patients with AAAs. Samples of normal aortic wall and serum were taken from 6 age-matched control patients. Quantitative gelatin-zymography and gelatinolytic soluble assays after acetyl-phenyl mercuric acid activation were performed on serum and tissue extracts, and the results were expressed in units on a comparative wet-weight basis. Histologic analysis was performed in parallel to score the inflammatory infiltrate. RESULTS: The luminal and parietal parts of the thrombus contained, respectively, 20- and 10-fold more gelantinolytic activity than the serum. The predominate form was MMP9. Although the total gelatinolytic activity was in the same range both in AAAs and in normal walls, a significantly higher proportion of MMP9 was found in the aneurysmal aortic walls. Furthermore, a significant proportion of MMP9 was under its processed active form, which was never observed in normal samples. A significantly higher proportion of MMP2 was also present as processed active form in AAA wall. This latter parameter positively correlated with the inflammatory score. CONCLUSIONS: The presence of activated MMP9 and MMP2 might contribute to the degradation of the extracellular matrix proteins that occurs during the development of aneurysms.", "author" : [ { "dropping-particle" : "", "family" : "Sakalihasan", "given" : "N", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Delvenne", "given" : "P", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "V", "family" : "Nusgens", "given" : "B", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Limet", "given" : "R", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Lapiere", "given" : "C M", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "J Vasc Surg", "edition" : "1996/07/01", "id" : "ITEM-7", "issue" : "1", "issued" : { "date-parts" : [ [ "1996" ] ] }, "language" : "eng", "note" : "Sakalihasan, N\nDelvenne, P\nNusgens, B V\nLimet, R\nLapiere, C M\nComparative Study\nResearch Support, Non-U.S. Gov't\nUnited states\nJournal of vascular surgery : official publication, the Society for Vascular Surgery [and] International Society for Cardiovascular Surgery, North American Chapter\nJ Vasc Surg. 1996 Jul;24(1):127-33.", "page" : "127-133", "title" : "Activated forms of MMP2 and MMP9 in abdominal aortic aneurysms", "type" : "article-journal", "volume" : "24" }, "uris" : [ "http://www.mendeley.com/documents/?uuid=7f897ea6-2459-4c90-baa9-9e7e4b34fae1" ] }, { "id" : "ITEM-8", "itemData" : { "ISBN" : "0950-821X (Print) 0950-821X (Linking)", "PMID" : "8270064", "abstract" : "Collagen and elastin are the main extracellular matrix proteins providing the aortic wall with adequate mechanical properties and resistance for proper function. Our study aimed at investigating the relationship between the elastin concentration of the wall of normal and aneurysmal abdominal aortas (AAA), the collagen concentration, and its extractability, as a function of their size. Infrarenal aortas were collected from 30 patients undergoing operative repair of abdominal aortic aneurysm. Age-matched control samples were obtained from eight autopsies of individuals without vascular disease. Samples were divided into five groups according to the aortic diameter: control group (group N, n = 8); < 50 mm (group I, n = 6; between 50-75 mm (group II, n = 10); > 75 mm (group III, n = 7); and ruptured (group IV, n = 7). The collagen concentration in samples from group I was similar to the controls. An increased collagen concentration was observed in group II and remained at the same level in the largest and ruptured aneurysms. Extractability of collagen was found to be increased in group III and was even higher in group IV. A highly significant reduction in elastin concentration was observed in group I and there was progressive reduction with increasing diameter and rupture. A significant correlation could be established between aortic diameter, increased collagen extractability and decreased elastin content.", "author" : [ { "dropping-particle" : "", "family" : "Sakalihasan", "given" : "N", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Heyeres", "given" : "A", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "V", "family" : "Nusgens", "given" : "B", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Limet", "given" : "R", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Lapiere", "given" : "C M", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Eur J Vasc Surg", "edition" : "1993/11/01", "id" : "ITEM-8", "issue" : "6", "issued" : { "date-parts" : [ [ "1993" ] ] }, "language" : "eng", "note" : "Sakalihasan, N\nHeyeres, A\nNusgens, B V\nLimet, R\nLapiere, C M\nResearch Support, Non-U.S. Gov't\nEngland\nEuropean journal of vascular surgery\nEur J Vasc Surg. 1993 Nov;7(6):633-7.", "page" : "633-637", "title" : "Modifications of the extracellular matrix of aneurysmal abdominal aortas as a function of their size", "type" : "article-journal", "volume" : "7" }, "uris" : [ "http://www.mendeley.com/documents/?uuid=c3e09e3e-ab24-4c90-91fe-196e26be5c11" ] } ], "mendeley" : { "formattedCitation" : "16,23,56,60\u201364", "plainTextFormattedCitation" : "16,23,56,60\u201364", "previouslyFormattedCitation" : "16,23,56,60\u201364" }, "properties" : { }, "schema" : "https://github.com/citation-style-language/schema/raw/master/csl-citation.json" }16,23,56,6064
Some recent registry-based reports suggest that the use of fluoroquinolones causes collagen breakdown in the aortic wall, which could increase the risk for hospital care or death from aortic disease (thoracic aortic aneurysms, dissection or AAA).ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "ISSN" : "1756-1833", "PMID" : "29519881", "abstract" : "OBJECTIVE To investigate whether oral fluoroquinolone use is associated with an increased risk of aortic aneurysm or dissection. DESIGN Nationwide historical cohort study using linked register data on patient characteristics, filled prescriptions, and cases of aortic aneurysm or dissection. SETTING Sweden, July 2006 to December 2013. PARTICIPANTS 360\u2009088 treatment episodes of fluoroquinolone use (78%ciprofloxacin) and propensity score matched comparator episodes of amoxicillin use (n=360\u2009088). MAIN OUTCOME MEASURES Cox regression was used to estimate hazard ratios for a first diagnosis of aortic aneurysm or dissection, defined as admission to hospital or emergency department for, or death due to, aortic aneurysm or dissection, within 60 days from start of treatment. RESULTS Within the 60 day risk period, the rate of aortic aneurysm or dissection was 1.2 cases per 1000 person years among fluoroquinolone users and 0.7 cases per 1000 person years among amoxicillin users. Fluoroquinolone use was associated with an increased risk of aortic aneurysm or dissection (hazard ratio 1.66 (95% confidence interval 1.12 to 2.46)), with an estimated absolute difference of 82 (95% confidence interval 15 to 181) cases of aortic aneurysm or dissection by 60 days per 1 million treatment episodes. In a secondary analysis, the hazard ratio for the association with fluoroquinolone use was 1.90 (1.22 to 2.96) for aortic aneurysm and 0.93 (0.38 to 2.29) for aortic dissection. CONCLUSIONS In a propensity score matched cohort, fluoroquinolone use was associated with an increased risk of aortic aneurysm or dissection. This association appeared to be largely driven by aortic aneurysm.", "author" : [ { "dropping-particle" : "", "family" : "Pasternak", "given" : "Bj\u00f6rn", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Inghammar", "given" : "Malin", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Svanstr\u00f6m", "given" : "Henrik", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "BMJ (Clinical research ed.)", "id" : "ITEM-1", "issued" : { "date-parts" : [ [ "2018" ] ] }, "page" : "k678", "title" : "Fluoroquinolone use and risk of aortic aneurysm and dissection: nationwide cohort study.", "type" : "article-journal", "volume" : "360" }, "uris" : [ "http://www.mendeley.com/documents/?uuid=56f6dd92-bca0-3e9a-87e2-d947d89f2c5c" ] } ], "mendeley" : { "formattedCitation" : "65", "plainTextFormattedCitation" : "65", "previouslyFormattedCitation" : "65" }, "properties" : { }, "schema" : "https://github.com/citation-style-language/schema/raw/master/csl-citation.json" }65
The reported rupture risk varies as a function of diameter, and derives from studies of patients left untreated due to comorbidities.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1016/j.ejvs.2014.10.007", "ISBN" : "1532-2165 (Electronic)\r1078-5884 (Linking)", "PMID" : "25542593", "abstract" : "INTRODUCTION: The primary objective of this study was to assess the duration of in-hospital survival in 57 patients with ruptured abdominal aortic aneurysms (RAAA) who did not undergo surgical intervention. REPORT: Two hours after registration in the emergency room, 58% (95% CI 45-71) of patients were still alive. The median survival was 2.2 hours (interquartile range 1-18). In a subgroup including 26 haemodynamically stable patients, survival after 2 hours was 96% (95% CI 89-100). CONCLUSION: In patients with an RAAA without surgical intervention, the duration of in-hospital survival is limited. However, a group of haemodynamically stable patients can be identified in whom survival is much longer.", "author" : [ { "dropping-particle" : "", "family" : "Beek", "given" : "S C", "non-dropping-particle" : "van", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Vahl", "given" : "A C", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Wisselink", "given" : "W", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Balm", "given" : "R", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Amsterdam Acute Aneurysm Trial", "given" : "Collaborators", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Eur J Vasc Endovasc Surg", "id" : "ITEM-1", "issue" : "2", "issued" : { "date-parts" : [ [ "2015" ] ] }, "note" : "van Beek, S C\nVahl, A C\nWisselink, W\nBalm, R\neng\nMulticenter Study\nResearch Support, Non-U.S. Gov't\nEngland\n2014/12/30 06:00\nEur J Vasc Endovasc Surg. 2015 Feb;49(2):163-5. doi: 10.1016/j.ejvs.2014.10.007. Epub 2014 Dec 24.", "page" : "163-165", "title" : "Fate of patients unwilling or unsuitable to undergo surgical intervention for a ruptured abdominal aortic aneurysm", "type" : "article-journal", "volume" : "49" }, "uris" : [ "http://www.mendeley.com/documents/?uuid=ec494464-e0e3-44f0-ac34-9a6e7e08e087" ] }, { "id" : "ITEM-2", "itemData" : { "DOI" : "joc20866 [pii]", "ISBN" : "0098-7484 (Print) 0098-7484 (Linking)", "PMID" : "12052126", "abstract" : "CONTEXT: Among patients with abdominal aortic aneurysm (AAA) who have high operative risk, repair is usually deferred until the AAA reaches a diameter at which rupture risk is thought to outweigh operative risk, but few data exist on rupture risk of large AAA. OBJECTIVE: To determine the incidence of rupture in patients with large AAA. DESIGN AND SETTING: Prospective cohort study in 47 Veterans Affairs medical centers. PATIENTS: Veterans (n = 198) with AAA of at least 5.5 cm for whom elective AAA repair was not planned because of medical contraindication or patient refusal. Patients were enrolled between April 1995 and April 2000 and followed up through July 2000 (mean, 1.52 years). MAIN OUTCOME MEASURE: Incidence of AAA rupture by strata of initial and attained diameter. RESULTS: Outcome ascertainment was complete for all patients. There were 112 deaths (57%) and the autopsy rate was 46%. Forty-five patients had probable AAA rupture. The 1-year incidence of probable rupture by initial AAA diameter was 9.4% for AAA of 5.5 to 5.9 cm, 10.2% for AAA of 6.0 to 6.9 cm (19.1% for the subgroup of 6.5-6.9 cm), and 32.5% for AAA of 7.0 cm or more. Much of the increased risk of rupture associated with initial AAA diameters of 6.5-7.9 cm was related to the likelihood that the AAA diameter would reach 8.0 cm during follow-up, after which 25.7% ruptured within 6 months. CONCLUSION: The rupture rate is substantial in high-operative-risk patients with AAA of at least 5.5 cm in diameter and increases with larger diameter.", "author" : [ { "dropping-particle" : "", "family" : "Lederle", "given" : "F A", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Johnson", "given" : "G R", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Wilson", "given" : "S E", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Ballard", "given" : "D J", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Jordan Jr.", "given" : "W D", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Blebea", "given" : "J", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Littooy", "given" : "F N", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Freischlag", "given" : "J A", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Bandyk", "given" : "D", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Rapp", "given" : "J H", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Salam", "given" : "A A", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "JAMA", "edition" : "2002/06/08", "id" : "ITEM-2", "issue" : "22", "issued" : { "date-parts" : [ [ "2002" ] ] }, "language" : "eng", "note" : "Lederle, Frank A\nJohnson, Gary R\nWilson, Samuel E\nBallard, David J\nJordan, William D Jr\nBlebea, John\nLittooy, Fred N\nFreischlag, Julie A\nBandyk, Dennis\nRapp, Joseph H\nSalam, Atef A\nVeterans Affairs Cooperative Study #417 Investigators\nMulticenter Study\nResearch Support, U.S. Gov't, Non-P.H.S.\nUnited States\nJAMA : the journal of the American Medical Association\nJAMA. 2002 Jun 12;287(22):2968-72.", "page" : "2968-2972", "title" : "Rupture rate of large abdominal aortic aneurysms in patients refusing or unfit for elective repair", "type" : "article-journal", "volume" : "287" }, "uris" : [ "http://www.mendeley.com/documents/?uuid=321ca0c8-71b5-45b5-a5c6-cee41ebf5661" ] } ], "mendeley" : { "formattedCitation" : "66,67", "plainTextFormattedCitation" : "66,67", "previouslyFormattedCitation" : "66,67" }, "properties" : { }, "schema" : "https://github.com/citation-style-language/schema/raw/master/csl-citation.json" }66,67 Recent North A m e r i c a n g u i d e l i n e s i n d i c a t e t h a t t h e r u p t u r e r i s k , b a s e d o n d i a m e t e r a l o n e , m a y b e l o w e r t h a n p r e v i o u s l y r e p o r t e d . P r e v i o u s l y , a n n u a l r u p t u r e r i s k s f o r p a t i e n t s w i t h < 4 0 m m A A A i s n e g l i g i b l e , i n p a t i e n t s w i t h A A A ( 4 0 "5 4 m m ) 0 . 7 - 1 . 0 % , i n 5 5 "5 9 m m A A A ; 9 %, in 60-69 mm AAA, 10% and in AAAs >70mm: 33 % have been reported. (lederle and JVS Chaikof guidelines) A contemporary pooled analysis indicates that the annual rupture risk would be 5.3% (55-70 mm) and 6.3% for AAA >70 mm. Women with small AAA appear to have a higher rupture risk than men.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1161/01.CIR.0000133279.07468.9F 01.CIR.0000133279.07468.9F [pii]", "ISBN" : "1524-4539 (Electronic) 0009-7322 (Linking)", "PMID" : "15210603", "abstract" : "BACKGROUND: Intervention to reduce abdominal aortic aneurysm (AAA) expansion and optimization of screening intervals would improve current surveillance programs. The aim of this study was to characterize AAA growth in a national cohort of patients with AAA both overall and by cardiovascular risk factors. METHODS AND RESULTS: In this study, 1743 patients were monitored for changes in AAA diameter by ultrasonography over a mean follow-up of 1.9 years. Mean initial AAA diameter and growth rate were 43 mm (range 28 to 85 mm) and 2.6 mm/year (95% range, -1.0 to 6.1 mm/year), respectively. Baseline diameter was strongly associated with growth, suggesting that AAA growth accelerates as the aneurysm enlarges. AAA growth rate was lower in those with low ankle/brachial pressure index and diabetes but higher for current smokers (all P<0.001). No other factor (including lipids and blood pressure) was associated with AAA growth. Intervals of 36, 24, 12, and 3 months for aneurysms of 35, 40, 45, and 50 mm, respectively, would restrict the probability of breaching the 55-mm limit at rescreening to below 1%. CONCLUSIONS: Annual, or less frequent, surveillance intervals are safe for all AAAs < or =45 mm in diameter. Smoking increases AAA growth, but atherosclerosis plays a minor role.", "author" : [ { "dropping-particle" : "", "family" : "Brady", "given" : "A R", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Thompson", "given" : "S G", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Fowkes", "given" : "F G", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Greenhalgh", "given" : "R M", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Powell", "given" : "J T", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Circulation", "edition" : "2004/06/24", "id" : "ITEM-1", "issue" : "1", "issued" : { "date-parts" : [ [ "2004" ] ] }, "language" : "eng", "note" : "Brady, Anthony R\nThompson, Simon G\nFowkes, F Gerald R\nGreenhalgh, Roger M\nPowell, Janet T\nUK Small Aneurysm Trial Participants\nResearch Support, Non-U.S. Gov't\nUnited States\nCirculation\nCirculation. 2004 Jul 6;110(1):16-21. Epub 2004 Jun 21.", "page" : "16-21", "title" : "Abdominal aortic aneurysm expansion: risk factors and time intervals for surveillance", "type" : "article-journal", "volume" : "110" }, "uris" : [ "http://www.mendeley.com/documents/?uuid=6ee74b62-f1f6-4276-ae2a-838f7efa35b3" ] }, { "id" : "ITEM-2", "itemData" : { "ISBN" : "0003-4932 (Print) 0003-4932 (Linking)", "PMID" : "10493476", "abstract" : "OBJECTIVE: To investigate risk factors associated with aneurysm rupture using patients randomized into the U.K. Small Aneurysm Trial (n = 1090) or monitored for aneurysm growth in the associated study (n = 1167). SUMMARY BACKGROUND DATA: The U.K. Small Aneurysm Trial has shown that ultrasound surveillance is a safe management option for patients with small abdominal aortic aneurysms (4.0 to 5.5 cm in diameter), with an annual rupture rate of 1%. METHODS: In the cohort of 2257 patients (79% male), aged 59 to 77 years, 103 instances of abdominal aortic aneurysm rupture were identified during the 7-year period of follow-up (1991-1998). Almost all patients (98%) had initial aneurysm diameters in the range of 3 to 6 cm, and the majority of ruptures (76%) occurred in patients with aneurysms > or =5 cm in diameter. Kaplan-Meier survival and Cox regression analysis were used to identify baseline risk factors associated with aneurysm rupture. RESULTS: After 3 years, the annual rate of aneurysm rupture was 2.2% (95% confidence interval 1.7 to 2.8). The risk of rupture was independently and significantly associated with female sex (p < 0.001), larger initial aneurysm diameter (p < 0.001), lower FEV1 (p = 0.004), current smoking (p = 0.01), and higher mean blood pressure (p = 0.01). Age, body mass index, serum cholesterol concentration, and ankle/brachial pressure index were not associated with an increased risk of aneurysm rupture. CONCLUSIONS: Within this cohort of patients, women had a threefold higher risk of aneurysm rupture than men. Effective control of blood pressure and cessation of smoking are likely to diminish the risk of rupture.", "author" : [ { "dropping-particle" : "", "family" : "Brown", "given" : "L C", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Powell", "given" : "J T", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Ann Surg", "edition" : "1999/09/24", "id" : "ITEM-2", "issue" : "3", "issued" : { "date-parts" : [ [ "1999" ] ] }, "language" : "eng", "note" : "Brown, L C\nPowell, J T\nClinical Trial\nRandomized Controlled Trial\nResearch Support, Non-U.S. Gov't\nUnited states\nAnnals of surgery\nAnn Surg. 1999 Sep;230(3):289-96; discussion 296-7.", "page" : "287-289", "title" : "Risk factors for aneurysm rupture in patients kept under ultrasound surveillance. UK Small Aneurysm Trial Participants", "type" : "article-journal", "volume" : "230" }, "uris" : [ "http://www.mendeley.com/documents/?uuid=489ae34b-76c1-4c97-871a-0d100e5b5ba1" ] } ], "mendeley" : { "formattedCitation" : "47,48", "plainTextFormattedCitation" : "47,48", "previouslyFormattedCitation" : "47,48" }, "properties" : { }, "schema" : "https://github.com/citation-style-language/schema/raw/master/csl-citation.json" }47,48
[H1] Mechanisms/pathophysiology
AAA is a complex disease with both genetic and environmental risk factors. Its pathobiology is now more understood, but based on histological and molecular evaluation of tissue samples of the abdominal aorta removed during open repair, mostly of large AAAs or aortas with occlusive disease. AAA is characterized by elastin fragmentation, v-SMC death, increased oxidative stress in the aortic wall and immune cell infiltration of the adventitia. Molecular studies using high-throughput microarray-based genome-wide analyses have identified biological pathways ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.18632/oncotarget.3848", "ISSN" : "1949-2553", "PMID" : "25944698", "abstract" : "Abdominal aortic aneurysm (AAA) and aortic occlusive disease (AOD) represent common causes of morbidity and mortality in elderly populations which were previously believed to have common aetiologies. The aim of this study was to assess the gene expression in human AAA and AOD. We performed microarrays using aortic specimen obtained from 20 patients with small AAAs (\u2264 55mm), 29 patients with large AAAs (> 55mm), 9 AOD patients, and 10 control aortic specimens obtained from organ donors. Some differentially expressed genes were validated by quantitative-PCR (qRT-PCR)/immunohistochemistry. We identified 840 and 1,014 differentially expressed genes in small and large AAAs, respectively. Immune-related pathways including cytokine-cytokine receptor interaction and T-cell-receptor signalling were upregulated in both small and large AAAs. Examples of validated genes included CTLA4 (2.01-fold upregulated in small AAA, P = 0.002), NKTR (2.37-and 2.66-fold upregulated in small and large AAA with P = 0.041 and P = 0.015, respectively), and CD8A (2.57-fold upregulated in large AAA, P = 0.004). 1,765 differentially expressed genes were identified in AOD. Pathways upregulated in AOD included metabolic and oxidative phosphorylation categories. The UCP2 gene was downregulated in AOD (3.73-fold downregulated, validated P = 0.017). In conclusion, the AAA and AOD transcriptomes were very different suggesting that AAA and AOD have distinct pathogenic mechanisms.", "author" : [ { "dropping-particle" : "", "family" : "Biros", "given" : "Erik", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "G\u00e4bel", "given" : "Gabor", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Moran", "given" : "Corey S.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Schreurs", "given" : "Charlotte", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Lindeman", "given" : "Jan H. N.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Walker", "given" : "Philip J.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Nataatmadja", "given" : "Maria", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "West", "given" : "Malcolm", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Holdt", "given" : "Lesca M.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Hinterseher", "given" : "Irene", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Pilarsky", "given" : "Christian", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Golledge", "given" : "Jonathan", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Oncotarget", "id" : "ITEM-1", "issue" : "15", "issued" : { "date-parts" : [ [ "2015", "5", "30" ] ] }, "page" : "12984-96", "title" : "Differential gene expression in human abdominal aortic aneurysm and aortic occlusive disease", "type" : "article-journal", "volume" : "6" }, "uris" : [ "http://www.mendeley.com/documents/?uuid=5bead374-ead4-3484-be3f-6ffa3ede81f2" ] }, { "id" : "ITEM-2", "itemData" : { "DOI" : "10.1186/1471-2164-8-237", "ISBN" : "1471-2164 (Electronic)\r1471-2164 (Linking)", "PMID" : "17634102", "abstract" : "BACKGROUND: Abdominal aortic aneurysms are a common disorder with an incompletely understood etiology. We used Illumina and Affymetrix microarray platforms to generate global gene expression profiles for both aneurysmal (AAA) and non-aneurysmal abdominal aorta, and identified genes that were significantly differentially expressed between cases and controls. RESULTS: Affymetrix and Illumina arrays included 18,057 genes in common; 11,542 (64%) of these genes were considered to be expressed in either aneurysmal or normal abdominal aorta. There were 3,274 differentially expressed genes with a false discovery rate (FDR) 17,68\u201374", "plainTextFormattedCitation" : "17,68\u201374", "previouslyFormattedCitation" : "17,68\u201374" }, "properties" : { }, "schema" : "https://github.com/citation-style-language/schema/raw/master/csl-citation.json" }17,6874 and demonstrated differences in the aortic wall between AAA and occlusive atherothrombotic aortic disease.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.18632/oncotarget.3848", "ISSN" : "1949-2553", "PMID" : "25944698", "abstract" : "Abdominal aortic aneurysm (AAA) and aortic occlusive disease (AOD) represent common causes of morbidity and mortality in elderly populations which were previously believed to have common aetiologies. The aim of this study was to assess the gene expression in human AAA and AOD. We performed microarrays using aortic specimen obtained from 20 patients with small AAAs (\u2264 55mm), 29 patients with large AAAs (> 55mm), 9 AOD patients, and 10 control aortic specimens obtained from organ donors. Some differentially expressed genes were validated by quantitative-PCR (qRT-PCR)/immunohistochemistry. We identified 840 and 1,014 differentially expressed genes in small and large AAAs, respectively. Immune-related pathways including cytokine-cytokine receptor interaction and T-cell-receptor signalling were upregulated in both small and large AAAs. Examples of validated genes included CTLA4 (2.01-fold upregulated in small AAA, P = 0.002), NKTR (2.37-and 2.66-fold upregulated in small and large AAA with P = 0.041 and P = 0.015, respectively), and CD8A (2.57-fold upregulated in large AAA, P = 0.004). 1,765 differentially expressed genes were identified in AOD. Pathways upregulated in AOD included metabolic and oxidative phosphorylation categories. The UCP2 gene was downregulated in AOD (3.73-fold downregulated, validated P = 0.017). In conclusion, the AAA and AOD transcriptomes were very different suggesting that AAA and AOD have distinct pathogenic mechanisms.", "author" : [ { "dropping-particle" : "", "family" : "Biros", "given" : "Erik", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "G\u00e4bel", "given" : "Gabor", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Moran", "given" : "Corey S.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Schreurs", "given" : "Charlotte", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Lindeman", "given" : "Jan H. N.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Walker", "given" : "Philip J.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Nataatmadja", "given" : "Maria", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "West", "given" : "Malcolm", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Holdt", "given" : "Lesca M.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Hinterseher", "given" : "Irene", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Pilarsky", "given" : "Christian", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Golledge", "given" : "Jonathan", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Oncotarget", "id" : "ITEM-1", "issue" : "15", "issued" : { "date-parts" : [ [ "2015", "5", "30" ] ] }, "page" : "12984-96", "title" : "Differential gene expression in human abdominal aortic aneurysm and aortic occlusive disease", "type" : "article-journal", "volume" : "6" }, "uris" : [ "http://www.mendeley.com/documents/?uuid=5bead374-ead4-3484-be3f-6ffa3ede81f2" ] } ], "mendeley" : { "formattedCitation" : "17", "plainTextFormattedCitation" : "17", "previouslyFormattedCitation" : "17" }, "properties" : { }, "schema" : "https://github.com/citation-style-language/schema/raw/master/csl-citation.json" }17
As compared to intimal atheroma, aneurysms are characterized by medial injury, mainly caused by proteolysis and oxidative processes. ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "ISBN" : "1524-4636 (Electronic)\r1079-5642 (Linking)", "PMID" : "11557661", "author" : [ { "dropping-particle" : "", "family" : "Michel", "given" : "J B", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Arterioscler Thromb Vasc Biol", "id" : "ITEM-1", "issue" : "9", "issued" : { "date-parts" : [ [ "2001" ] ] }, "note" : "Michel, J B\neng\nComment\nEditorial\n2001/09/15 10:00\nArterioscler Thromb Vasc Biol. 2001 Sep;21(9):1389-92.", "page" : "1389-1392", "title" : "Contrasting outcomes of atheroma evolution: intimal accumulation versus medial destruction", "type" : "article-journal", "volume" : "21" }, "uris" : [ "http://www.mendeley.com/documents/?uuid=40063d02-3952-437e-891d-310c01607bcf" ] } ], "mendeley" : { "formattedCitation" : "81", "plainTextFormattedCitation" : "81", "previouslyFormattedCitation" : "81" }, "properties" : { }, "schema" : "https://github.com/citation-style-language/schema/raw/master/csl-citation.json" }81 The ECM (elastin and collagen) supports the hemodynamic load of the aortic wall. The action of proteases that progressively degrade the ECM is considered the most influential mechanism for the development of AAAs (Fig 4
[H2] Atherothrombosis and hemodynamics
Atherothrombotic diseases are specific to arteries with atheroma localising preferentially to specific sites, including those proximal to bifurcations. Atheroma begins with an outward convection of plasma lipoproteins through the wall. A part of them (LDL) could be retained in the arterial intima, forming fatty streaks. These fatty streaks evolve towards plaque formation and intraplaque clotting by luminal intraparietal bleedings or intraplaque haemorrhages in the abdominal aorta, forming the pathological substrate for both occlusive disease and AAA.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "S0140-6736(05)66459-8 [pii] 10.1016/S0140-6736(05)66459-8 [doi]", "ISBN" : "1474-547X (Electronic) 0140-6736 (Linking)", "PMID" : "15866312", "abstract" : "Abdominal aortic aneurysms cause 1.3% of all deaths among men aged 65-85 years in developed countries. These aneurysms are typically asymptomatic until the catastrophic event of rupture. Repair of large or symptomatic aneurysms by open surgery or endovascular repair is recommended, whereas repair of small abdominal aortic aneurysms does not provide a significant benefit. Abdominal aortic aneurysm is linked to the degradation of the elastic media of the atheromatous aorta. An inflammatory cell infiltrate, neovascularisation, and production and activation of various proteases and cytokines contribute to the development of this disorder, although the underlying mechanisms are unknown. In this Seminar, we aim to provide an updated review of the pathophysiology, current and new diagnostic procedures, assessment, and treatment of abdominal aortic aneurysm to provide family practitioners with a working knowledge of this disorder.", "author" : [ { "dropping-particle" : "", "family" : "Sakalihasan", "given" : "N", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Limet", "given" : "R", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Defawe", "given" : "O D", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Lancet", "edition" : "2005/05/04", "id" : "ITEM-1", "issue" : "9470", "issued" : { "date-parts" : [ [ "2005" ] ] }, "language" : "eng", "note" : "Sakalihasan, N\nLimet, R\nDefawe, O D\nResearch Support, Non-U.S. Gov't\nReview\nEngland\nLancet\nLancet. 2005 Apr 30-May 6;365(9470):1577-89.", "page" : "1577-1589", "title" : "Abdominal aortic aneurysm", "type" : "article-journal", "volume" : "365" }, "uris" : [ "http://www.mendeley.com/documents/?uuid=0fcf1cfb-3c11-43fa-9d25-2c4a31838a62" ] } ], "mendeley" : { "formattedCitation" : "46", "plainTextFormattedCitation" : "46", "previouslyFormattedCitation" : "46" }, "properties" : { }, "schema" : "https://github.com/citation-style-language/schema/raw/master/csl-citation.json" }46 The abdominal aortas propensity for atherothrombotic dilation is due to specific hemodynamic conditions associated with the iliac bifurcation and the ensuing: (i) outward radial transportation of plasma molecules and microparticles ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1160/TH14-10-0899", "ISBN" : "2567-689X (Electronic)\r0340-6245 (Linking)", "PMID" : "26422658", "abstract" : "The intraluminal thrombus (ILT) of human abdominal aortic aneurysm (AAA) has been suggested to damage the underlying aortic wall, but previous work found scant activity of soluble proteases in the abluminal layer of the ILT, adjacent to the aneurysm. We hypothesised that transmembrane proteases carried by membrane microvesicles (MV) from dying cells remain active in the abluminal ILT. ILTs and AAA segments collected from 21 patients during surgical repair were assayed for two major transmembrane proteases, ADAM10 (a disintegrin and metalloprotease-10) and ADAM17. We also exposed cultured cells to tobacco smoke and assessed ADAM10 and ADAM17 expression and release on MVs. Immunohistochemistry showed abundant ADAM10 and ADAM17 protein in the ILT and underlying aneurysmal aorta. Domain-specific antibodies indicated both transmembrane and shed ADAM17. Importantly, ADAM10 and ADAM 17 in the abluminal ILT were enzymatically active. Electron microscopy of abluminal ILT and aortic wall showed MVs with ADAM10 and ADAM17. By flow cytometry, ADAM-positive microvesicles from abluminal ILT carried the neutrophil marker CD66, but not the platelet marker CD61. Cultured HL60 neutrophils exposed to tobacco smoke extract showed increased ADAM10 and ADAM17 content, cleavage of these molecules into active forms, and release of MVs carrying mature ADAM10 and detectable ADAM17. In conclusion, our results implicate persistent, enzymatically active ADAMs on MVs in the abluminal ILT, adjacent to the aneurysmal wall. The production of ADAM10- and ADAM17-positive MVs from smoke-exposed neutrophils provides a novel molecular mechanism for the vastly accelerated risk of AAA in smokers.", "author" : [ { "dropping-particle" : "", "family" : "Folkesson", "given" : "M", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Li", "given" : "C", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Frebelius", "given" : "S", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Swedenborg", "given" : "J", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Wagsater", "given" : "D", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Williams", "given" : "K J", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Eriksson", "given" : "P", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Roy", "given" : "J", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Liu", "given" : "M L", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Thromb Haemost", "id" : "ITEM-1", "issue" : "6", "issued" : { "date-parts" : [ [ "2015" ] ] }, "note" : "Folkesson, Maggie\nLi, Chunjun\nFrebelius, Siw\nSwedenborg, Jesper\nWagsater, Dick\nWilliams, Kevin Jon\nEriksson, Per\nRoy, Joy\nLiu, Ming-Ling\neng\nGermany\n2015/10/01 06:00\nThromb Haemost. 2015 Nov 25;114(6):1165-74. doi: 10.1160/TH14-10-0899. Epub 2015 Sep 17.", "page" : "1165-1174", "title" : "Proteolytically active ADAM10 and ADAM17 carried on membrane microvesicles in human abdominal aortic aneurysms", "type" : "article-journal", "volume" : "114" }, "uris" : [ "http://www.mendeley.com/documents/?uuid=142e4f2f-2dd0-4bdc-a2c3-d5dfd6fe1c78" ] } ], "mendeley" : { "formattedCitation" : "75", "plainTextFormattedCitation" : "75", "previouslyFormattedCitation" : "75" }, "properties" : { }, "schema" : "https://github.com/citation-style-language/schema/raw/master/csl-citation.json" }75 through the wall and (ii) collisions of circulating cells between one another and the aortic wall (Fig 3). Vollmar, thirty years ago showed that AAA was more frequent in men with above-knee amputation, and greater curvature of the aorta developed on the opposite side of the non-amputed leg,ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "ISBN" : "0140-6736 (Print)\r0140-6736 (Linking)", "PMID" : "2571760", "abstract" : "The infrarenal aorta was examined by ultrasound in 329 men who had lost a leg in World War II and in 702 war veterans. The groups were similar in terms of age and risk factors for arteriosclerosis. Abdominal aortic aneurysms were found in 5.8% of the amputees compared with 1.1% of the non-amputees. Unilateral flow reduction after leg amputation causes an asymmetrical flow pattern at the aortic bifurcation, and this is probably the main cause of late damage to the aorta.", "author" : [ { "dropping-particle" : "", "family" : "Vollmar", "given" : "J F", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Paes", "given" : "E", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Pauschinger", "given" : "P", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Henze", "given" : "E", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Friesch", "given" : "A", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Lancet", "id" : "ITEM-1", "issue" : "8667", "issued" : { "date-parts" : [ [ "1989" ] ] }, "note" : "Vollmar, J F\nPaes, E\nPauschinger, P\nHenze, E\nFriesch, A\neng\nResearch Support, Non-U.S. Gov't\nEngland\nLondon, England\n1989/10/07 00:00\nLancet. 1989 Oct 7;2(8667):834-5.", "page" : "834-835", "title" : "Aortic aneurysms as late sequelae of above-knee amputation", "type" : "article-journal", "volume" : "2" }, "uris" : [ "http://www.mendeley.com/documents/?uuid=6b5298d8-5cd4-4c11-abb2-8f64a6151c27" ] } ], "mendeley" : { "formattedCitation" : "76", "plainTextFormattedCitation" : "76", "previouslyFormattedCitation" : "76" }, "properties" : { }, "schema" : "https://github.com/citation-style-language/schema/raw/master/csl-citation.json" }76 suggesting that reflexion waves on bifurcations can play an important role in the development and lateralization of AAAs. Hemodynamics also contribute to the understanding of the difference between the role of the intraluminal thrombus (ILT) at low vs high pressure systems. In the left atrium with a low pressure, the ILT mainly pertains to embolic risk, whereas in the aorta with high pressure, radial convection impacts the ILT in the wall contributing to a progressive dilation and risk of rupture.
Since the gradient of pressure between the circulating blood (120-80 mmHg) in large arteries is much higher than the interstitial pressure in the adventitia of the aorta (15 mmHg), proteases released by neutrophils, or directly plasma-borne zymogens, are outwardly conveyed through the wall, provoking ECM degradation and progressive dilation.
In AAA, at constant pressure, the tensile load progressively increases in relation to the increase in the radius and the decrease in wall thickness (Laplace law). Moreover, the cyclic stretching of the aortic ECM provokes a systolic peak of tensile stress on the wall, repeated 3.109 times during a human life of 80 years, creating biomechanical fatigue of the ECM, in synergy with the proteolytic injury (FIG. 3).
[H3] The role of the ILT during the development of AAA
The structure of AAAs is spatially organized, from inside to outside, with a multilayered ILT, a thin degraded media with few VSMCs and elastic components, and an inflammatory and/or fibrotic adventitia. Due to the presence of the ILT, there is neither endothelium nor intima in AAAs.
The role of ILT is linked to its biological activities, continuously renewed at the luminal interface with blood. In AAA, ILT is a spatio-temporal dynamic neo-tissue, able to degrade the underlying aortic wall, due to consumption of fibrinogen, circulating cellular elements such as polymorphic neutrophils (PMNs), plateletsADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.2353/ajpath.2006.050868", "ISBN" : "0002-9440 (Print)\r0002-9440 (Linking)", "PMID" : "16507915", "abstract" : "Human abdominal aortic aneurysm (AAA) expansion has been linked to the presence of a mural thrombus. Here we explored the mechanism of the continual luminal renewal of this thrombus and its ability to release biological markers potentially detectable in plasma. We also explored the ability of platelet inhibition to pacify the thrombus and to limit aneurysm progression in an experimental model. Blood samples and mural thrombi were collected in 20 AAA patients. In parallel, segments of sodium dodecyl sulfate-decellularized guinea pig aorta were xenografted onto the abdominal aorta of 30 rats to induce aneurysms. Fifteen rats received abciximab treatment and fifteen received irrelevant immunoglobulins. Procoagulant activity and platelet activation markers (microparticles, sP-selectin, sGPV, sCD40L) were increased threefold to fivefold in eluates from the luminal thrombus layer compared to other layers. All these markers were increased twofold to fivefold in patients' plasma compared to matched controls (P < 0.005). In the rat model, abciximab reduced both thrombus area and aneurysmal enlargement (P < 0.05). Platelet aggregation is probably responsible for the renewal of the thrombus in AAA. The luminal thrombus released markers of platelet activation that could easily be detected in plasma. Platelet inhibition limited aortic aneurysm expansion in a rat model, providing new therapeutic perspectives in the prevention of AAA enlargement.", "author" : [ { "dropping-particle" : "", "family" : "Touat", "given" : "Z", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Ollivier", "given" : "V", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Dai", "given" : "J", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Huisse", "given" : "M G", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Bezeaud", "given" : "A", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Sebbag", "given" : "U", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Palombi", "given" : "T", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Rossignol", "given" : "P", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Meilhac", "given" : "O", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Guillin", "given" : "M C", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Michel", "given" : "J B", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Am J Pathol", "id" : "ITEM-1", "issue" : "3", "issued" : { "date-parts" : [ [ "2006" ] ] }, "note" : "Touat, Ziad\nOllivier, Veronique\nDai, Jianping\nHuisse, Marie-Genevieve\nBezeaud, Annie\nSebbag, Uriel\nPalombi, Tony\nRossignol, Patrick\nMeilhac, Olivier\nGuillin, Marie-Claude\nMichel, Jean-Baptiste\neng\nResearch Support, Non-U.S. Gov't\n2006/03/02 09:00\nAm J Pathol. 2006 Mar;168(3):1022-30. doi: 10.2353/ajpath.2006.050868.", "page" : "1022-1030", "title" : "Renewal of mural thrombus releases plasma markers and is involved in aortic abdominal aneurysm evolution", "type" : "article-journal", "volume" : "168" }, "uris" : [ "http://www.mendeley.com/documents/?uuid=b862a65c-bcc7-4cc6-98fc-b1d1c0890412" ] } ], "mendeley" : { "formattedCitation" : "90", "plainTextFormattedCitation" : "90", "previouslyFormattedCitation" : "90" }, "properties" : { }, "schema" : "https://github.com/citation-style-language/schema/raw/master/csl-citation.json" }90 and red blood cells (RBCs),ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1160/TH13-08-0721", "ISBN" : "2567-689X (Electronic)\r0340-6245 (Linking)", "PMID" : "24599423", "abstract" : "Iron deposits are observed in tissue of abdominal aortic aneurysm (AAA) patients, although the underlying mechanisms are not completely elucidated. Therefore we explored circulating markers of iron metabolism in AAA patients, and tested if they could serve as biomarkers of AAA. Increased red blood cell (RBC)-borne iron retention and transferrin, transferrin receptor and ferritin expression was observed in AAA tissue compared to control aorta (immunohistochemistry and western blot). In contrast, decreased circulating iron, transferrin, mean corpuscular haemoglobin concentration (MCHC) and haemoglobin concentration, along with circulating RBC count, were observed in AAA patients (aortic diameter >3 cm, n=114) compared to controls (aortic diameter <3 cm, n=88) (ELISA), whereas hepcidin concentrations were increased in AAA subjects (MS/MS assay). Moreover, iron, transferrin and haemoglobin levels were negatively, and hepcidin positively, correlated with aortic diameter in AAA patients. The association of low haemoglobin with AAA presence or aortic diameter was independent of specific risk factors. Moreover, MCHC negatively correlated with thrombus area in another cohort of AAA patients (aortic diameter 3-5 cm, n=357). We found that anaemia was significantly more prevalent in AAA patients (aortic diameter >5 cm, n=8,912) compared to those in patients with atherosclerotic aorto-iliac occlusive disease (n=17,737) [adjusted odds ratio=1.77 (95% confidence interval: 1.61;1.93)]. Finally, the mortality risk among AAA patients with anaemia was increased by almost 30% [adjusted hazard ratio: 1.29 (95% confidence interval: 1.16;1.44)] as compared to AAA subjects without anaemia. In conclusion, local iron retention and altered iron recycling associated to high hepcidin and low transferrin systemic concentrations could lead to reduced circulating haemoglobin levels in AAA patients. Low haemoglobin levels are independently associated to AAA presence and clinical outcome.", "author" : [ { "dropping-particle" : "", "family" : "Martinez-Pinna", "given" : "R", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Lindholt", "given" : "J S", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Madrigal-Matute", "given" : "J", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Blanco-Colio", "given" : "L M", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Esteban-Salan", "given" : "M", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Torres-Fonseca", "given" : "M M", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Lefebvre", "given" : "T", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Delbosc", "given" : "S", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Laustsen", "given" : "J", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Driss", "given" : "F", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Vega de Ceniga", "given" : "M", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Gouya", "given" : "L", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Weiss", "given" : "G", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Egido", "given" : "J", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Meilhac", "given" : "O", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Michel", "given" : "J B", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Martin-Ventura", "given" : "J", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Thromb Haemost", "id" : "ITEM-1", "issue" : "1", "issued" : { "date-parts" : [ [ "2014" ] ] }, "note" : "Martinez-Pinna, R\nLindholt, J S\nMadrigal-Matute, J\nBlanco-Colio, L M\nEsteban-Salan, M\nTorres-Fonseca, M M\nLefebvre, T\nDelbosc, S\nLaustsen, J\nDriss, F\nVega de Ceniga, M\nGouya, L\nWeiss, G\nEgido, J\nMeilhac, O\nMichel, J-B\nMartin-Ventura, J\neng\nGermany\n2014/03/07 06:00\nThromb Haemost. 2014 Jul 3;112(1):87-95. doi: 10.1160/TH13-08-0721. Epub 2014 Mar 6.", "page" : "87-95", "title" : "From tissue iron retention to low systemic haemoglobin levels, new pathophysiological biomarkers of human abdominal aortic aneurysm", "type" : "article-journal", "volume" : "112" }, "uris" : [ "http://www.mendeley.com/documents/?uuid=bd93b3e9-8094-47ca-b17a-1996b8767b8f" ] } ], "mendeley" : { "formattedCitation" : "91", "plainTextFormattedCitation" : "91", "previouslyFormattedCitation" : "91" }, "properties" : { }, "schema" : "https://github.com/citation-style-language/schema/raw/master/csl-citation.json" }91 as well as macromolecules such as high-density lipoproteins (HDL)ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1160/TH14-10-0874", "ISBN" : "2567-689X (Electronic)\r0340-6245 (Linking)", "PMID" : "25789510", "abstract" : "Abdominal aortic aneurysm (AAA) evolution is unpredictable, and there is no therapy except surgery for patients with an aortic size> 5 cm (large AAA). We aimed to identify new potential biomarkers that could facilitate prognosis and treatment of patients with AAA. A differential quantitative proteomic analysis of plasma proteins was performed in AAA patients at different stages of evolution [small AAA (aortic size=3-5 cm) vs large AAA] using iTRAQ labelling, high-throughput nano-LC-MS/MS and a novel multi-layered statistical model. Among the proteins identified, ApoA-I was decreased in patients with large AAA compared to those with small AAA. These results were validated by ELISA on plasma samples from small (n=90) and large AAA (n=26) patients (150+/- 3 vs 133+/- 5 mg/dl, respectively, p< 0.001). ApoA-I levels strongly correlated with HDL-Cholesterol (HDL-C) concentration (r=0.9, p< 0.001) and showed a negative correlation with aortic size (r=-0.4, p< 0.01) and thrombus volume (r=-0.3, p< 0.01), which remained significant after adjusting for traditional risk factors. In a prospective study, HDL-C independently predicted aneurysmal growth rate in multiple linear regression analysis (n=122, p=0.008) and was inversely associated with need for surgical repair (Adjusted hazard ratio: 0.18, 95 % confidence interval: 0.04-0.74, p=0.018). In a nation-wide Danish registry, we found lower mean HDL-C concentration in large AAA patients (n=6,560) compared with patients with aorto-iliac occlusive disease (n=23,496) (0.89+/- 2.99 vs 1.59+/- 5.74 mmol/l, p< 0.001). Finally, reduced mean aortic AAA diameter was observed in AngII-infused mice treated with ApoA-I mimetic peptide compared with saline-injected controls. In conclusion, ApoA-I/HDL-C systemic levels are negatively associated with AAA evolution. Therapies targeting HDL functionality could halt AAA formation.", "author" : [ { "dropping-particle" : "", "family" : "Burillo", "given" : "E", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Lindholt", "given" : "J S", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Molina-Sanchez", "given" : "P", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Jorge", "given" : "I", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Martinez-Pinna", "given" : "R", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Blanco-Colio", "given" : "L M", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Tarin", "given" : "C", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Torres-Fonseca", "given" : "M M", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Esteban", "given" : "M", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Laustsen", "given" : "J", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Ramos-Mozo", "given" : "P", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Calvo", "given" : "E", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Lopez", "given" : "J A", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Vega de Ceniga", "given" : "M", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Michel", "given" : "J B", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Egido", "given" : "J", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Andres", "given" : "V", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Vazquez", "given" : "J", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Meilhac", "given" : "O", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Martin-Ventura", "given" : "J L", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Thromb Haemost", "id" : "ITEM-1", "issue" : "6", "issued" : { "date-parts" : [ [ "2015" ] ] }, "note" : "Burillo, Elena\nLindholt, Jes S\nMolina-Sanchez, Pedro\nJorge, Immaculada\nMartinez-Pinna, Roxana\nBlanco-Colio, Luis Miguel\nTarin, Carlos\nTorres-Fonseca, Monica Maria\nEsteban, Margarita\nLaustsen, Jesper\nRamos-Mozo, Priscilla\nCalvo, Enrique\nLopez, Juan Antonio\nVega de Ceniga, Melina\nMichel, Jean-Baptiste\nEgido, Jesus\nAndres, Vicente\nVazquez, Jesus\nMeilhac, Olivier\nMartin-Ventura, Jose Luis\neng\nComparative Study\nObservational Study\nResearch Support, Non-U.S. Gov't\nGermany\n2015/03/20 06:00\nThromb Haemost. 2015 Jun;113(6):1335-46. doi: 10.1160/TH14-10-0874. Epub 2015 Mar 19.", "page" : "1335-1346", "title" : "ApoA-I/HDL-C levels are inversely associated with abdominal aortic aneurysm progression", "type" : "article-journal", "volume" : "113" }, "uris" : [ "http://www.mendeley.com/documents/?uuid=22f14139-da2d-4453-b3e7-b613288cb92c" ] } ], "mendeley" : { "formattedCitation" : "92", "plainTextFormattedCitation" : "92", "previouslyFormattedCitation" : "92" }, "properties" : { }, "schema" : "https://github.com/citation-style-language/schema/raw/master/csl-citation.json" }92 and ILT development is also enhanced by trapped bacteria.
Rarely, patients with AAA have been identified as sufffering from consumptive coagulopathy. These patients have decreased platelet counts and plasma fibrinogen levels, provoking systemic bleeding, with associated increases in plasma D-dimers.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1007/s11684-017-0498-7", "ISBN" : "2095-0225 (Electronic)\r2095-0217 (Linking)", "PMID" : "28233246", "abstract" : "Chronic disseminated intravascular coagulation (DIC) is a rare but devastating complication of aortic aneurysm (AA). This study investigated the clinical manifestations, laboratory findings, and treatment of patients with AA-associated chronic DIC (AA-DIC) and explored the mechanisms, duration, and therapeutic response of AA-DIC. We retrospectively reviewed the medical records of 235 AA patients admitted at the Peking Union Medical College Hospital between September 2009 and January 2015. The patients were classified as those with DIC (AA-DIC) and those without DIC (non-DIC). The AA-DIC group showed a significantly higher proportion of female patients and a significantly longer AA disease course than the non-DIC group did. The AA-DIC patients presented mural thrombi, dissecting aneurysms, a family history of AA, and diabetes significantly more frequently than the non-DIC patients did. Furthermore, multiple regression analyses revealed that sex, mural thrombus, aneurysm type, diabetes, and stent surgery are possible independent risk factors for AA-DIC patients. Fifty-two (22.1%) patients presented AA-DIC. Among these patients, 43 had non-typical DIC and 9 had typical DIC; the mortality rate of the latter was 22.2%. The mean age of the patients with typical DIC was significantly higher than of that of patients with non-typical DIC. The non-typical DIC patients also presented abnormal coagulation disorders of varying degrees. Furthermore, heparin or low-molecular-weight heparin improved the clinical symptoms and laboratory parameters in patients with AA and typical DIC. Thus, chronic DIC should be considered in patients with AA.", "author" : [ { "dropping-particle" : "", "family" : "Zhang", "given" : "Y", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Li", "given" : "C", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Shen", "given" : "M", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Liu", "given" : "B", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Zeng", "given" : "X", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Shen", "given" : "T", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Front Med", "id" : "ITEM-1", "issue" : "1", "issued" : { "date-parts" : [ [ "2017" ] ] }, "note" : "Zhang, Yun\nLi, Chen\nShen, Min\nLiu, Bao\nZeng, Xuejun\nShen, Ti\neng\nChina\n2017/02/25 06:00\nFront Med. 2017 Mar;11(1):62-67. doi: 10.1007/s11684-017-0498-7. Epub 2017 Mar 2.", "page" : "62-67", "title" : "Aortic aneurysm and chronic disseminated intravascular coagulation: a retrospective study of 235 patients", "type" : "article-journal", "volume" : "11" }, "uris" : [ "http://www.mendeley.com/documents/?uuid=879a8fb9-2050-4ac9-936a-945abeea2d5a" ] } ], "mendeley" : { "formattedCitation" : "93", "plainTextFormattedCitation" : "93", "previouslyFormattedCitation" : "93" }, "properties" : { }, "schema" : "https://github.com/citation-style-language/schema/raw/master/csl-citation.json" }93 D-dimers are the hallmark of fibrinolysis and plasmin activation playing a major role in proteolytic injury of the wall. The consumption of RBCs, platelets and fibrinogen suggests that the dynamic occurring within the pathological ILT is the main determinant of the absence of stromal cell colonization, including local VSMC and circulating mesenchymal cell progenitors, limiting the healing capacities.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "ISBN" : "0002-9440 (Print)\r0002-9440 (Linking)", "PMID" : "15161642", "abstract" : "To explore possible mechanisms responsible for the absence of cell re-colonization of mural thrombi in aneurysms, we analyzed the release and storage of leukocyte proteases in the most luminal layer versus intermediate and abluminal layers of 10 mural thrombi of human abdominal aortic aneurysms. The luminal layer contained many polymorphonuclear leukocytes (PMNs), which released pro-matrix metalloproteinase (MMP)-9 and MMP-8. Leukocyte elastase was also stored and released by the luminal layer (immunohistochemistry, activity on synthetic substrates, and casein zymography). Acid buffer allowed extraction of leukocyte elastase from the luminal layer, which was inhibited by elastase inhibitors. Casein zymography of luminal extracts and conditioned medium from formyl-methionyl-leucyl-phenylalanine (fMLP)-stimulated PMNs exhibited a similar lysis pattern, corresponding to elastase activity. Smooth muscle cell (SMC) seeding resulted in colonization of the intermediate thrombus layer ex vivo but not of the luminal layer. Extracts of the luminal layer induced loss of anchorage of both cultured human smooth muscle cells and stromal cells of bone marrow origin (anoikis). This anoikis was prevented by preincubation of the extracts with serine protease inhibitors. Moreover, adhesion of human SMCs and stromal bone marrow cells on fibrin gels was strongly inhibited when the gel was preincubated with pure elastase, medium of fMLP-stimulated PMNs, or extracts of luminal layers of mural thrombi. This loss of cell anchorage was prevented by the preincubation of the medium or extracts with alpha(1)-antitrypsin, but not when alpha(1)-antitrypsin was added after binding of elastase to the fibrin gel. In conclusion, elastase released by PMNs trapped within the mural thrombus impairs the spontaneous anchorage of mesenchymal cells to a fibrin matrix. This phenomenon could be one mechanism by which cellular healing of the mural thrombus in aneurysms is prevented.", "author" : [ { "dropping-particle" : "", "family" : "Fontaine", "given" : "V", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Touat", "given" : "Z", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Mtairag el", "given" : "M", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Vranckx", "given" : "R", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Louedec", "given" : "L", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Houard", "given" : "X", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Andreassian", "given" : "B", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Sebbag", "given" : "U", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Palombi", "given" : "T", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Jacob", "given" : "M P", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Meilhac", "given" : "O", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Michel", "given" : "J B", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Am J Pathol", "id" : "ITEM-1", "issue" : "6", "issued" : { "date-parts" : [ [ "2004" ] ] }, "note" : "Fontaine, Vincent\nTouat, Ziad\nMtairag, El Mostafa\nVranckx, Roger\nLouedec, Liliane\nHouard, Xavier\nAndreassian, Bernard\nSebbag, Uriel\nPalombi, Tonino\nJacob, Marie-Paule\nMeilhac, Olivier\nMichel, Jean-Baptiste\neng\nResearch Support, Non-U.S. Gov't\n2004/05/27 05:00\nAm J Pathol. 2004 Jun;164(6):2077-87.", "page" : "2077-2087", "title" : "Role of leukocyte elastase in preventing cellular re-colonization of the mural thrombus", "type" : "article-journal", "volume" : "164" }, "uris" : [ "http://www.mendeley.com/documents/?uuid=5577d121-8ce0-42d8-9b2e-87c81280b867" ] } ], "mendeley" : { "formattedCitation" : "94", "plainTextFormattedCitation" : "94", "previouslyFormattedCitation" : "94" }, "properties" : { }, "schema" : "https://github.com/citation-style-language/schema/raw/master/csl-citation.json" }94 These biological activities are not dependent on the ILT volume, but on its age: the fresher the ILT, the more active it is.
A recent review summarized numerous publications on the experimental animal models of AAA.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1161/ATVBAHA.116.308534", "ISSN" : "1079-5642", "PMID" : "28062500", "abstract" : "Human abdominal aortic aneurysm (AAA) pathophysiology is not yet completely understood. In conductance arteries, the insoluble extracellular matrix, synthesized by vascular smooth muscle cells, assumes the function of withstanding the intraluminal arterial blood pressure. Progressive loss of this function through extracellular matrix proteolysis is a main feature of AAAs. As most patients are now treated via endovascular approaches, surgical AAA specimens have become rare. Animal models provide valuable complementary insights into AAA pathophysiology. Current experimental AAA models involve induction of intraluminal dilation (nondissecting AAAs) or a contained intramural rupture (dissecting models). Although the ideal model should reproduce the histological characteristics and natural history of the human disease, none of the currently available animal models perfectly do so. Experimental models try to represent the main pathophysiological determinants of AAAs: genetic or acquired defects in extracellular matrix, loss of vascular smooth muscle cells, and innate or adaptive immune response. Nevertheless, most models are characterized by aneurysmal stabilization and healing after a few weeks because of cessation of the initial stimulus. Recent studies have focused on ways to optimize existing models to allow continuous aneurysmal growth. This review aims to discuss the relevance and recent advances of current animal AAA models. VISUAL OVERVIEW An online visual overview is available for this article.", "author" : [ { "dropping-particle" : "", "family" : "S\u00e9n\u00e9maud", "given" : "Jean", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Caligiuri", "given" : "Giuseppina", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Etienne", "given" : "Harry", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Delbosc", "given" : "Sandrine", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Michel", "given" : "Jean-Baptiste", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Coscas", "given" : "Rapha\u00ebl", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Arteriosclerosis, Thrombosis, and Vascular Biology", "id" : "ITEM-1", "issue" : "3", "issued" : { "date-parts" : [ [ "2017", "3" ] ] }, "page" : "401-410", "title" : "Translational Relevance and Recent Advances of Animal Models of Abdominal Aortic AneurysmHighlights", "type" : "article-journal", "volume" : "37" }, "uris" : [ "http://www.mendeley.com/documents/?uuid=650f45f9-5848-3598-8a27-219d0f06932e" ] } ], "mendeley" : { "formattedCitation" : "96", "plainTextFormattedCitation" : "96", "previouslyFormattedCitation" : "96" }, "properties" : { }, "schema" : "https://github.com/citation-style-language/schema/raw/master/csl-citation.json" }96 One of the common features of these models is that the progression of the dilation stops with the cessation of the initial stimulus (elastase, Angiotensin II, calcium chloride) initiating a process of healing by mesenchymal cells (mainly vSMC). To the best of our knowledge, only repeated injections of bacteria (with their preferential localisation in the ILT), would continuously cause wall injury, thereby enhancing the dilation and possible subsequent rupture.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1371/journal.pone.0018679", "ISBN" : "1932-6203 (Electronic) 1932-6203 (Linking)", "PMID" : "21533243", "abstract" : "BACKGROUND: Abdominal Aortic Aneurysms (AAAs) represent a particular form of atherothrombosis where neutrophil proteolytic activity plays a major role. We postulated that neutrophil recruitment and activation participating in AAA growth may originate in part from repeated episodes of periodontal bacteremia. METHODS AND FINDINGS: Our results show that neutrophil activation in human AAA was associated with Neutrophil Extracellular Trap (NET) formation in the IntraLuminal Thrombus, leading to the release of cell-free DNA. Human AAA samples were shown to contain bacterial DNA with high frequency (11/16), and in particular that of Porphyromonas gingivalis (Pg), the most prevalent pathogen involved in chronic periodontitis, a common form of periodontal disease. Both DNA reflecting the presence of NETs and antibodies to Pg were found to be increased in plasma of patients with AAA. Using a rat model of AAA, we demonstrated that repeated injection of Pg fostered aneurysm development, associated with pathological characteristics similar to those observed in humans, such as the persistence of a neutrophil-rich luminal thrombus, not observed in saline-injected rats in which a healing process was observed. CONCLUSIONS: Thus, the control of periodontal disease may represent a therapeutic target to limit human AAA progression.", "author" : [ { "dropping-particle" : "", "family" : "Delbosc", "given" : "S", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Alsac", "given" : "J M", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Journe", "given" : "C", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Louedec", "given" : "L", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Castier", "given" : "Y", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Bonnaure-Mallet", "given" : "M", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Ruimy", "given" : "R", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Rossignol", "given" : "P", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Bouchard", "given" : "P", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Michel", "given" : "J B", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Meilhac", "given" : "O", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "PLoS One", "edition" : "2011/05/03", "id" : "ITEM-1", "issue" : "4", "issued" : { "date-parts" : [ [ "2011" ] ] }, "language" : "eng", "note" : "Delbosc, Sandrine\nAlsac, Jean-Marc\nJourne, Clement\nLouedec, Liliane\nCastier, Yves\nBonnaure-Mallet, Martine\nRuimy, Raymond\nRossignol, Patrick\nBouchard, Philippe\nMichel, Jean-Baptiste\nMeilhac, Olivier\nResearch Support, Non-U.S. Gov't\nUnited States\nPloS one\nPLoS One. 2011 Apr 13;6(4):e18679. doi: 10.1371/journal.pone.0018679.", "page" : "e18679", "title" : "Porphyromonas gingivalis participates in pathogenesis of human abdominal aortic aneurysm by neutrophil activation. Proof of concept in rats", "type" : "article-journal", "volume" : "6" }, "uris" : [ "http://www.mendeley.com/documents/?uuid=a9d9fba3-d55f-43fc-8d69-89129420d6dc" ] } ], "mendeley" : { "formattedCitation" : "95", "plainTextFormattedCitation" : "95", "previouslyFormattedCitation" : "95" }, "properties" : { }, "schema" : "https://github.com/citation-style-language/schema/raw/master/csl-citation.json" }95
[H2] Extracellular matrix
As compared to intimal atheroma, aneurysms are characterized by medial injury, mainly caused by proteolysis and oxidative processes. ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "ISBN" : "1524-4636 (Electronic)\r1079-5642 (Linking)", "PMID" : "11557661", "author" : [ { "dropping-particle" : "", "family" : "Michel", "given" : "J B", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Arterioscler Thromb Vasc Biol", "id" : "ITEM-1", "issue" : "9", "issued" : { "date-parts" : [ [ "2001" ] ] }, "note" : "Michel, J B\neng\nComment\nEditorial\n2001/09/15 10:00\nArterioscler Thromb Vasc Biol. 2001 Sep;21(9):1389-92.", "page" : "1389-1392", "title" : "Contrasting outcomes of atheroma evolution: intimal accumulation versus medial destruction", "type" : "article-journal", "volume" : "21" }, "uris" : [ "http://www.mendeley.com/documents/?uuid=40063d02-3952-437e-891d-310c01607bcf" ] } ], "mendeley" : { "formattedCitation" : "81", "plainTextFormattedCitation" : "81", "previouslyFormattedCitation" : "81" }, "properties" : { }, "schema" : "https://github.com/citation-style-language/schema/raw/master/csl-citation.json" }81 The ECM (elastin and collagen) supports the hemodynamic load of the aortic wall. The action of proteases that progressively degrade the ECM is considered the most influential mechanism for the development of AAAs (Fig 4
The blood-containing function of the arterial wall mainly depends on the ECM, synthesized and matured in close vicinity of VSMCs. Lysyl oxidase, synthesized and secreted by the VSMCs, is the main enzyme involved in maturation of fibrillar structures, rendering them insoluble. The degradation of the ECM is largely due to proteases. The first studies describing a potential role for proteases were the seminal studies of Busutil and colleagues.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "ISBN" : "0022-4804 (Print)\r0022-4804 (Linking)", "PMID" : "6917898", "author" : [ { "dropping-particle" : "", "family" : "Busuttil", "given" : "R W", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Rinderbriecht", "given" : "H", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Flesher", "given" : "A", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Carmack", "given" : "C", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "J Surg Res", "id" : "ITEM-1", "issue" : "3", "issued" : { "date-parts" : [ [ "1982" ] ] }, "note" : "Busuttil, R W\nRinderbriecht, H\nFlesher, A\nCarmack, C\neng\nComparative Study\n1982/03/01 00:00\nJ Surg Res. 1982 Mar;32(3):214-7.", "page" : "214-217", "title" : "Elastase activity: the role of elastase in aortic aneurysm formation", "type" : "article-journal", "volume" : "32" }, "uris" : [ "http://www.mendeley.com/documents/?uuid=557ebbc4-ac86-402b-93b2-90a9ef504b36" ] } ], "mendeley" : { "formattedCitation" : "83", "plainTextFormattedCitation" : "83", "previouslyFormattedCitation" : "83" }, "properties" : { }, "schema" : "https://github.com/citation-style-language/schema/raw/master/csl-citation.json" }83 Elastin damage was preferentially associated with progressive dilatation, whereas collagen damage led to rupture.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "ISBN" : "0004-0010 (Print)\r0004-0010 (Linking)", "PMID" : "6322726", "abstract" : "Studies were performed in vitro on cylindrical segments of 56 canine common carotid arteries, 32 human external iliac arteries, nine internal iliac arteries, and ten common iliac arteries, using purified elastase and purified collagenase. Treatment with elastase caused the canine vessels to dilate but to remain intact. Similar results were obtained with the human vessels, except that treatment with elastase caused only slight dilation. All canine and human vessels treated with collagenase ruptured. We concluded that wall integrity depends on intact collagen rather than elastin. Comparison between external iliac arteries and internal and common iliac arteries showed that the latter vessels exhibited dramatically greater dilatation and compliance changes after treatment with collagenase. This finding corresponds to the greater tendency of aneurysms to develop in internal and common iliac arteries.", "author" : [ { "dropping-particle" : "", "family" : "Dobrin", "given" : "P B", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Baker", "given" : "W H", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Gley", "given" : "W C", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Arch Surg", "id" : "ITEM-1", "issue" : "4", "issued" : { "date-parts" : [ [ "1984" ] ] }, "note" : "Dobrin, P B\nBaker, W H\nGley, W C\neng\nHE-08682/PHS HHS/\nResearch Support, U.S. Gov't, Non-P.H.S.\nResearch Support, U.S. Gov't, P.H.S.\nChicago, Ill. : 1960\n1984/04/01 00:00\nArch Surg. 1984 Apr;119(4):405-9.", "page" : "405-409", "title" : "Elastolytic and collagenolytic studies of arteries. Implications for the mechanical properties of aneurysms", "type" : "article-journal", "volume" : "119" }, "uris" : [ "http://www.mendeley.com/documents/?uuid=4c9e20d7-74c0-43d9-a9c1-95073cd4d404" ] } ], "mendeley" : { "formattedCitation" : "84", "plainTextFormattedCitation" : "84", "previouslyFormattedCitation" : "84" }, "properties" : { }, "schema" : "https://github.com/citation-style-language/schema/raw/master/csl-citation.json" }84 Two protease families are predominantly linked to AAA progression: Serine proteases which directly degrade ECM or indirectly via adhesive proteins, and activated matrix metalloproteinases (MMPs) ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "S0741-5214(96)70153-2 [pii]", "ISBN" : "0741-5214 (Print) 0741-5214 (Linking)", "PMID" : "8691515", "abstract" : "PURPOSE: This consistent observation of a reduction of the elastin concentration in abdominal aortic aneurysms (AAAs) has led us to investigate in AAA specimens two metalloproteinases that display elastase activity, MMP2 (gelatinase A/72kDa) and MMP9 (gelatinase B/92 kDa). METHODS: Samples of full-thickness aortic wall, adherent thrombus, and serum were collected in 10 patients with AAAs. Samples of normal aortic wall and serum were taken from 6 age-matched control patients. Quantitative gelatin-zymography and gelatinolytic soluble assays after acetyl-phenyl mercuric acid activation were performed on serum and tissue extracts, and the results were expressed in units on a comparative wet-weight basis. Histologic analysis was performed in parallel to score the inflammatory infiltrate. RESULTS: The luminal and parietal parts of the thrombus contained, respectively, 20- and 10-fold more gelantinolytic activity than the serum. The predominate form was MMP9. Although the total gelatinolytic activity was in the same range both in AAAs and in normal walls, a significantly higher proportion of MMP9 was found in the aneurysmal aortic walls. Furthermore, a significant proportion of MMP9 was under its processed active form, which was never observed in normal samples. A significantly higher proportion of MMP2 was also present as processed active form in AAA wall. This latter parameter positively correlated with the inflammatory score. CONCLUSIONS: The presence of activated MMP9 and MMP2 might contribute to the degradation of the extracellular matrix proteins that occurs during the development of aneurysms.", "author" : [ { "dropping-particle" : "", "family" : "Sakalihasan", "given" : "N", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Delvenne", "given" : "P", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "V", "family" : "Nusgens", "given" : "B", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Limet", "given" : "R", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Lapiere", "given" : "C M", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "J Vasc Surg", "edition" : "1996/07/01", "id" : "ITEM-1", "issue" : "1", "issued" : { "date-parts" : [ [ "1996" ] ] }, "language" : "eng", "note" : "Sakalihasan, N\nDelvenne, P\nNusgens, B V\nLimet, R\nLapiere, C M\nComparative Study\nResearch Support, Non-U.S. Gov't\nUnited states\nJournal of vascular surgery : official publication, the Society for Vascular Surgery [and] International Society for Cardiovascular Surgery, North American Chapter\nJ Vasc Surg. 1996 Jul;24(1):127-33.", "page" : "127-133", "title" : "Activated forms of MMP2 and MMP9 in abdominal aortic aneurysms", "type" : "article-journal", "volume" : "24" }, "uris" : [ "http://www.mendeley.com/documents/?uuid=7f897ea6-2459-4c90-baa9-9e7e4b34fae1" ] } ], "mendeley" : { "formattedCitation" : "63", "plainTextFormattedCitation" : "63", "previouslyFormattedCitation" : "63" }, "properties" : { }, "schema" : "https://github.com/citation-style-language/schema/raw/master/csl-citation.json" }63 which can directly degrade ECM.
The leukocyte elastase (serine protease) ADDIN EN.CITE Fontaine2004110(14)11011017Fontaine, V.Touat, Z.Mtairag el, M.Vranckx, R.Louedec, L.Houard, X.Andreassian, B.Sebbag, U.Palombi, T.Jacob, M. P.Meilhac, O.Michel, J. B.Institut National de la Sante et de la Recherche Medicale (INSERM) Unit 460, Cardiovascular Remodeling, Centre Hospitale Universitaire (CHU) Xavier Bichat, Paris, France.Role of leukocyte elastase in preventing cellular re-colonization of the mural thrombusAm J Pathol2077-8716462004Jun15161642http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=15161642is able to degrade the fibrillar ECM. Plasmin (serine protease) is able to both degrade the intermediate adhesive proteins, provoking VSMC detachment and apoptosis,ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1096/fj.02-0687fje", "ISBN" : "1530-6860 (Electronic)\r0892-6638 (Linking)", "PMID" : "12738809", "abstract" : "Smooth muscle cell (SMC) rarefaction is involved in the development of several vascular pathologies. We suggest that the plasminogen activation system is a potential extracellular signal that can induce pericellular proteolysis and apoptosis of vascular SMCs. Using primary cultures of arterial SMCs, we show that plasmin generated from plasminogen on the cell surface induces cell retraction and fibronectin fragmentation, leading to detachment and morphological/biochemical changes characteristic of apoptosis (also called anoikis). The generation of cell-bound plasmin mediated by tissue-type plasminogen activator (t-PA), constitutively expressed by VSMCs, requires binding of plasminogen to the cell surface and is inhibited by epsilon-aminocaproic acid (IC50=0.9+/-0.2 mM), a competitor of plasminogen binding to membrane glycoproteins. Conversely, addition of alpha2-antiplasmin, which blocks free plasmin in the cell supernatant, could not fully prevent anoikis. Finally, an MMP inhibitor failed to prevent VSMC anoikis, arguing for a direct involvement of plasmin in this phenomenon. Indeed, similar changes are induced by plasmin directly added to VSMCs or to arterial rings, ex-vivo. We show for the first time that pathological anoikis can be triggered by a process that requires functional assembly of the plasminogen activation system on the surface of VSMCs.", "author" : [ { "dropping-particle" : "", "family" : "Meilhac", "given" : "O", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Ho-Tin-Noe", "given" : "B", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Houard", "given" : "X", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Philippe", "given" : "M", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Michel", "given" : "J B", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Angles-Cano", "given" : "E", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "FASEB J", "id" : "ITEM-1", "issue" : "10", "issued" : { "date-parts" : [ [ "2003" ] ] }, "note" : "Meilhac, Olivier\nHo-Tin-Noe, Benoit\nHouard, Xavier\nPhilippe, Monique\nMichel, Jean-Baptiste\nAngles-Cano, Eduardo\neng\n2003/05/10 05:00\nFASEB J. 2003 Jul;17(10):1301-3. doi: 10.1096/fj.02-0687fje. Epub 2003 May 8.", "page" : "1301-1303", "title" : "Pericellular plasmin induces smooth muscle cell anoikis", "type" : "article-journal", "volume" : "17" }, "uris" : [ "http://www.mendeley.com/documents/?uuid=3be79a54-1f9b-4799-addf-140b877c2362" ] } ], "mendeley" : { "formattedCitation" : "85", "plainTextFormattedCitation" : "85", "previouslyFormattedCitation" : "85" }, "properties" : { }, "schema" : "https://github.com/citation-style-language/schema/raw/master/csl-citation.json" }85 and to activate the pro-MMPs. Plasminogen is activated into plasmin on ILT fibrin, by tissue or urokinase plasminogen activator (t-PA or u-PA, serine proteases). U-PA and leukocyte elastase are released by neutrophils.
MMP9 (metalloproteinase) is released in association with gelatinaseassociated lipocalin (NGAL), by neutrophil activation and deathADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "07080427 [pii]", "ISBN" : "0340-6245 (Print) 0340-6245 (Linking)", "PMID" : "17721627", "abstract" : "It has been suggested that the intraluminal thrombus of abdominal aortic aneurysms (AAAs) predisposes for AAA enlargement and rupture. The growth of the AAA is dependent on proteolytic degradation of elastin. Here, we analysed whether the neutrophil gelatinase-associated lipocalin (NGAL) is expressed within the thrombus and the aneurysm wall. NGAL can bind to metalloproteinase-9 (MMP-9) and inhibit its degradation, thereby preserving enzymatic activity. Biopsies were obtained from thrombus-free and thrombus-covered aneurysm wall and the intraluminal thrombus from patients undergoing elective surgery for AAA. Immunohistochemistry and real-time PCR were used to study NGAL and MMP-9 expression. Immunoprecipitation, gel zymography, Western blot and ELISA were used to detect and quantify NGAL/MMP-9 complexes. NGAL was detected in the thrombus, the interface between the thrombus and the underlying wall and in the wall itself. Double staining showed that neutrophils are the major source of NGAL expression. Immunoprecipitation of MMP-9 with antibody against NGAL showed that complexes of NGAL and active MMP-9 were present in thrombus, the interface fluid and the aneurysm wall. Western blot analyses using non-reducing conditions and gel zymography demonstrated that high-molecular-weight complexes of NGAL/MMP-9 were present within the different regions. The concentration of the NGAL/MMP-9 complex was highest in the luminal part of the thrombus. In conclusion, NGAL in complex with activated MMP-9 is present in AAA wall and thrombus. Neutrophil-derived NGAL could enhance the proteolytic activity associated with AAA, but the importance of this mechanism for aneurysm growth remains to be shown.", "author" : [ { "dropping-particle" : "", "family" : "Folkesson", "given" : "M", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Kazi", "given" : "M", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Zhu", "given" : "C", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Silveira", "given" : "A", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Hemdahl", "given" : "A L", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Hamsten", "given" : "A", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Hedin", "given" : "U", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Swedenborg", "given" : "J", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Eriksson", "given" : "P", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Thromb Haemost", "edition" : "2007/08/28", "id" : "ITEM-1", "issue" : "2", "issued" : { "date-parts" : [ [ "2007" ] ] }, "language" : "eng", "note" : "Folkesson, Maggie\nKazi, Monsur\nZhu, Chaoyong\nSilveira, Angela\nHemdahl, Anne-Louise\nHamsten, Anders\nHedin, Ulf\nSwedenborg, Jesper\nEriksson, Per\nResearch Support, Non-U.S. Gov't\nGermany\nThrombosis and haemostasis\nThromb Haemost. 2007 Aug;98(2):427-33.", "page" : "427-433", "title" : "Presence of NGAL/MMP-9 complexes in human abdominal aortic aneurysms", "type" : "article-journal", "volume" : "98" }, "uris" : [ "http://www.mendeley.com/documents/?uuid=2ca77619-627a-428a-ad90-f11dc4e3faea" ] } ], "mendeley" : { "formattedCitation" : "86", "plainTextFormattedCitation" : "86", "previouslyFormattedCitation" : "86" }, "properties" : { }, "schema" : "https://github.com/citation-style-language/schema/raw/master/csl-citation.json" }86, and is acts directly on elastin. MMPs are synthetized as inactive precursors and must be locally activated by partial plasmin proteolysis, and /or by reactive oxygen species.
The partial disappearance of VSMC is mainly due to the proteolytic and oxidative environment in the aortic wall. Plasmin and elastase are able to provoke v-SMC detachment and death.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1161/01.ATV.0000099882.52647.E4\r01.ATV.0000099882.52647.E4 [pii]", "ISBN" : "1524-4636 (Electronic)\r1079-5642 (Linking)", "PMID" : "14551156", "abstract" : "Anoikis is defined as programmed cell death induced by the loss of cell/matrix interactions. Adhesion to structural glycoproteins of the extracellular matrix is necessary for survival of the differentiated adherent cells in the cardiovascular system, including endothelial cells, smooth muscle cells, fibroblasts, and cardiac myocytes. Adhesion is also a key factor for the differentiation of mesenchymal stem cells. In particular, fibronectin is considered a factor of survival and differentiation for many adherent cells. Adhesion generates cell tensional integrity (tensegrity) and repression of apoptotic signals, whereas detachment has the opposite effect. Anoikis plays a physiological role by regulating cell homeostasis in tissues. However, anoikis can also be involved in pathological processes, as illustrated by the resistance to anoikis in cancer and its enhancement in degenerative tissue remodeling. Extracellular mediators of anoikis include matrix retraction, leading to loss of tensegrity in fibroblasts, pharmacological disengagement of integrins by RGD-like peptides and fragments of fibronectin, and focal adhesion disassembly by fragments of thrombospondin, plasminogen activator-1, and high-molecular-weight kininogen. In addition to binding of the RGD peptide by integrins, the engagement of the heparin binding sites of adhesive glycoproteins with glycosaminoglycans on the cell surface is also involved in the prevention of cell detachment-induced apoptosis. Proteases able to degrade adhesive glycoproteins, such as fibronectin, induce anoikis of vascular adherent cells. Active proteases can either be secreted directly by inflammatory cells, as elastase and cathepsin G by polymorphonuclear leukocytes, chymase and tryptase by mast cells, and granzymes by lymphocytes, or generated from circulating zymogens by activation in close contact with the cells. This is the case for the pericellular conversion of plasminogen to plasmin, which degrades fibronectin and induces anoikis of smooth muscle cells. Involvement of proteases has also been proposed in the apoptotic response of cultured adherent cells to serum starvation. Anoikis is probably involved in pathological remodeling of cardiovascular tissues, including cardiac myocyte detachment in heart failure, deendothelialization and plaque rupture in atherosclerosis, and smooth muscle cell disappearance in aneurysms and varicose veins. The absence of cell adhesion and growth resulting from cleavage of adhesive p\u2026", "author" : [ { "dropping-particle" : "", "family" : "Michel", "given" : "J B", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Arterioscler Thromb Vasc Biol", "edition" : "2003/10/11", "id" : "ITEM-1", "issue" : "12", "issued" : { "date-parts" : [ [ "2003" ] ] }, "language" : "eng", "note" : "Michel, Jean-Baptiste\nResearch Support, Non-U.S. Gov't\nReview\nUnited States\nArteriosclerosis, thrombosis, and vascular biology\nArterioscler Thromb Vasc Biol. 2003 Dec;23(12):2146-54. Epub 2003 Oct 9.", "page" : "2146-2154", "title" : "Anoikis in the cardiovascular system: known and unknown extracellular mediators", "type" : "article-journal", "volume" : "23" }, "uris" : [ "http://www.mendeley.com/documents/?uuid=73ebce7b-51b8-4242-8390-62cbe9be53da" ] }, { "id" : "ITEM-2", "itemData" : { "DOI" : "10.1161/CIRCRESAHA.116.304899", "ISSN" : "0009-7330", "PMID" : "25563840", "abstract" : "RATIONALE Depletion of medial smooth muscle cell (SMC) is a major pathological characteristic of abdominal aortic aneurysm (AAA), although the mechanism by which these cells are eliminated remains incompletely understood. We reasoned that necroptosis, a recently described form of necrosis mediated by receptor-interacting protein kinase 3 (RIP3), may contribute to AAA pathology through the induction of SMC death and the significant production of inflammatory cytokines. OBJECTIVE To test the hypothesis that RIP3-mediated necroptosis is actively involved in aneurysm pathogenesis. METHODS AND RESULTS RIP3 and RIP1 levels were found to be elevated in human AAAs, most noticeably in SMCs. Elevations of RIP3 and SMC necrosis were also observed in the elastase-induced mouse model of AAAs. Deletion of one or both copies of Rip3 prevented AAA formation. By transplanting Rip3(+/-) aortae to Rip3(+/+) mice, we demonstrated that reduced Rip3 expression in arterial wall was the primary cause of aneurysm resistance. In vitro, adenoviral overexpression of RIP3 was sufficient to trigger SMC necroptosis. Protein kinase C-delta contributed to tumor necrosis factor-\u03b1-induced SMC necroptosis by regulating Rip3 expression. Furthermore, Rip3 deficiency impaired tumor necrosis factor-\u03b1-induced inflammatory gene expression in aortic SMCs, which was at least in part because of attenuation of p65 Ser536 phosphorylation. In vivo, the lack of RIP3 diminished activation of p65 in SMCs, implicating a necrosis independent function of RIP3 in aneurysms. CONCLUSIONS Enhanced RIP3 signaling in aneurysmal tissues contributes to AAA progression by causing SMC necroptosis, as well as stimulating vascular inflammation, and therefore may serve as a novel therapeutic target for AAA treatment.", "author" : [ { "dropping-particle" : "", "family" : "Wang", "given" : "Q.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Liu", "given" : "Z.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Ren", "given" : "J.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Morgan", "given" : "S.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Assa", "given" : "C.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Liu", "given" : "B.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Circulation Research", "id" : "ITEM-2", "issue" : "4", "issued" : { "date-parts" : [ [ "2015", "2", "13" ] ] }, "page" : "600-611", "title" : "Receptor-Interacting Protein Kinase 3 Contributes to Abdominal Aortic Aneurysms via Smooth Muscle Cell Necrosis and Inflammation", "type" : "article-journal", "volume" : "116" }, "uris" : [ "http://www.mendeley.com/documents/?uuid=6a403abd-adaf-3e6f-88d7-e43868b41183" ] } ], "mendeley" : { "formattedCitation" : "78,79", "plainTextFormattedCitation" : "78,79", "previouslyFormattedCitation" : "78,79" }, "properties" : { }, "schema" : "https://github.com/citation-style-language/schema/raw/master/csl-citation.json" }78,79 In parallel, intense oxidative stress is able to provoke v-SMC death. For instance, ceroids, a hallmark of oxidation are highly toxic for v-SMC. ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1016/j.atherosclerosis.2014.03.020", "ISSN" : "00219150", "PMID" : "24726899", "abstract" : "Atherothrombotic diseases are still major causes of inability and mortality and fighting atherothrombosis remains a public health priority. The involvement of repeated intraplaque haemorrhages (IPH) in the evolution of atherothrombotic lesions towards complications was proposed as early as 1936. This important topic has been recently revisited and reviewed. Histological observations have been corroborated by magnetic resonance imaging (MRI) of human carotid atheroma, identifying IPH as the main determinant of plaque evolution towards rupture. Beside the intimal integration of asymptomatic luminal coagulum, inward sprouting of neovessels from the adventitia towards the plaque, is one source of IPH in human atheroma. We recently described that directed neo-angiogenesis from the adventitia towards the plaque, across the media, is initiated by lipid mediators generated by the plaque on the luminal side, outwardly convected to the medial VSMCs. Subsequent stimulation of VSMC PPAR-\u03b3 receptors induces VEGF expression which causes centripetal sprouting of adventitial vessels. However, this neovascularization is considered to be immature and highly susceptible to leakage. The main cellular components of IPH are Red Blood Cells (RBCs), which with their haemoglobin content and their cell membrane components, particularly enriched in unesterified cholesterol, participate in both the oxidative process and cholesterol accumulation. The presence of iron, glycophorin A and ceroids provides evidence of RBCs. IPH also convey blood leukocytes and platelets and are sites prone to weak pathogen contamination. Therefore prevention and treatment of the biological consequences of IPH pave the way to innovative preventive strategies and improved therapeutic options in human atherothrombotic diseases.", "author" : [ { "dropping-particle" : "", "family" : "Michel", "given" : "Jean-Baptiste", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Martin-Ventura", "given" : "Jos\u00e9 Luis", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Nicoletti", "given" : "Antonino", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Ho-Tin-No\u00e9", "given" : "Benoit", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Atherosclerosis", "id" : "ITEM-1", "issue" : "2", "issued" : { "date-parts" : [ [ "2014", "6" ] ] }, "page" : "311-319", "title" : "Pathology of human plaque vulnerability: Mechanisms and consequences of intraplaque haemorrhages", "type" : "article-journal", "volume" : "234" }, "uris" : [ "http://www.mendeley.com/documents/?uuid=a44f82a2-f66b-324a-8fa9-4b339115b2fe" ] }, { "id" : "ITEM-2", "itemData" : { "DOI" : "10.1161/CIRCRESAHA.116.304899", "ISSN" : "0009-7330", "PMID" : "25563840", "abstract" : "RATIONALE Depletion of medial smooth muscle cell (SMC) is a major pathological characteristic of abdominal aortic aneurysm (AAA), although the mechanism by which these cells are eliminated remains incompletely understood. We reasoned that necroptosis, a recently described form of necrosis mediated by receptor-interacting protein kinase 3 (RIP3), may contribute to AAA pathology through the induction of SMC death and the significant production of inflammatory cytokines. OBJECTIVE To test the hypothesis that RIP3-mediated necroptosis is actively involved in aneurysm pathogenesis. METHODS AND RESULTS RIP3 and RIP1 levels were found to be elevated in human AAAs, most noticeably in SMCs. Elevations of RIP3 and SMC necrosis were also observed in the elastase-induced mouse model of AAAs. Deletion of one or both copies of Rip3 prevented AAA formation. By transplanting Rip3(+/-) aortae to Rip3(+/+) mice, we demonstrated that reduced Rip3 expression in arterial wall was the primary cause of aneurysm resistance. In vitro, adenoviral overexpression of RIP3 was sufficient to trigger SMC necroptosis. Protein kinase C-delta contributed to tumor necrosis factor-\u03b1-induced SMC necroptosis by regulating Rip3 expression. Furthermore, Rip3 deficiency impaired tumor necrosis factor-\u03b1-induced inflammatory gene expression in aortic SMCs, which was at least in part because of attenuation of p65 Ser536 phosphorylation. In vivo, the lack of RIP3 diminished activation of p65 in SMCs, implicating a necrosis independent function of RIP3 in aneurysms. CONCLUSIONS Enhanced RIP3 signaling in aneurysmal tissues contributes to AAA progression by causing SMC necroptosis, as well as stimulating vascular inflammation, and therefore may serve as a novel therapeutic target for AAA treatment.", "author" : [ { "dropping-particle" : "", "family" : "Wang", "given" : "Q.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Liu", "given" : "Z.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Ren", "given" : "J.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Morgan", "given" : "S.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Assa", "given" : "C.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Liu", "given" : "B.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Circulation Research", "id" : "ITEM-2", "issue" : "4", "issued" : { "date-parts" : [ [ "2015", "2", "13" ] ] }, "page" : "600-611", "title" : "Receptor-Interacting Protein Kinase 3 Contributes to Abdominal Aortic Aneurysms via Smooth Muscle Cell Necrosis and Inflammation", "type" : "article-journal", "volume" : "116" }, "uris" : [ "http://www.mendeley.com/documents/?uuid=6a403abd-adaf-3e6f-88d7-e43868b41183" ] } ], "mendeley" : { "formattedCitation" : "79,80", "plainTextFormattedCitation" : "79,80", "previouslyFormattedCitation" : "79,80" }, "properties" : { }, "schema" : "https://github.com/citation-style-language/schema/raw/master/csl-citation.json" }79,80
All these proteases are regenerated in the most luminal layer of the ILT, are outwardly convected and percolate through the wall, provoking ECM degradation and vSMC loss .ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1002/path.2148", "ISBN" : "0022-3417 (Print)\r0022-3417 (Linking)", "PMID" : "17352452", "abstract" : "Development and progression of acquired abdominal aortic aneurysms (AAAs) involve proteolytic activity. In the present study, we investigate the distribution of fibrinolytic system components within mural thrombi of human AAAs. 20 mural thrombi and the remaining AAA walls were dissected. The luminal, intermediate and abluminal thrombus layers, and media and adventitia were separately incubated in cell culture medium. Conditioned media were then analysed for plasminogen activators (PAs), plasminogen activator inhibitor-1 (PAI-1), free-plasmin, plasmin alpha(2)-antiplasmin complexes (PAPs) and D-dimers release. In parallel, PA and PAI-1 mRNA expression analysis was performed by RT-PCR. The study was completed by immunohistochemical localization of these components in AAA, ex vivo functional imaging using (99m)Tc-aprotinin as a ligand and measurement of PAP and D-dimer plasma levels. All fibrinolytic system components were present in each aneurysmal layer. However, the mural thrombus was the main source of active serine-protease release. Interestingly, the luminal layer of the thrombus released greater amounts of PAPs and D-dimers. This paralleled the preferential immunolocalization of plasminogen and PAs, and the (99m)Tc-aprotinin scintigraphic signal observed in the luminal pole of the thrombus. In contrast, mRNA expression analysis showed an exclusive synthesis of tPA and PAI-1 within the wall, whereas uPA mRNA was also expressed within the thrombus. Taken together, these results suggest that the increased plasma concentrations of PAPs and D-dimers found in AAA patients are related to mural thrombus proteolytic activity, thus explaining their known link with AAA progression. Components of the fibrinolytic system could also represent a target for functional imaging of thrombus activities in AAA.", "author" : [ { "dropping-particle" : "", "family" : "Houard", "given" : "X", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Rouzet", "given" : "F", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Touat", "given" : "Z", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Philippe", "given" : "M", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Dominguez", "given" : "M", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Fontaine", "given" : "V", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Sarda-Mantel", "given" : "L", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Meulemans", "given" : "A", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Guludec", "given" : "D", "non-dropping-particle" : "Le", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Meilhac", "given" : "O", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Michel", "given" : "J B", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "J Pathol", "id" : "ITEM-1", "issue" : "1", "issued" : { "date-parts" : [ [ "2007" ] ] }, "note" : "Houard, X\nRouzet, F\nTouat, Z\nPhilippe, M\nDominguez, M\nFontaine, V\nSarda-Mantel, L\nMeulemans, A\nLe Guludec, D\nMeilhac, O\nMichel, J-B\neng\nResearch Support, Non-U.S. Gov't\nEngland\n2007/03/14 09:00\nJ Pathol. 2007 May;212(1):20-8. doi: 10.1002/path.2148.", "page" : "20-28", "title" : "Topology of the fibrinolytic system within the mural thrombus of human abdominal aortic aneurysms", "type" : "article-journal", "volume" : "212" }, "uris" : [ "http://www.mendeley.com/documents/?uuid=f04b93b0-3733-4bbf-9864-c248d7da780c" ] } ], "mendeley" : { "formattedCitation" : "87", "plainTextFormattedCitation" : "87", "previouslyFormattedCitation" : "87" }, "properties" : { }, "schema" : "https://github.com/citation-style-language/schema/raw/master/csl-citation.json" }87 The proteolytic injuries are partly limited by antiproteases, including tissue serpins and tissue inhibitors of MMPs (TIMPs). Therefore, such plasma proteases/antiprotease complexes could hypothetically serve as circulating markers of AAA progression but the evidence for their use in clinical practice remains to be substantiated. The most sensitive biomarkers would potentially be plasma MMP-9,ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "ISBN" : "1524-4539 (Electronic) 0009-7322 (Linking)", "PMID" : "11568071", "abstract" : "BACKGROUND: Structural alterations of aortic wall resulting from degradation of matrix proteins by matrix metalloproteinases (MMPs) characterize abdominal aortic aneurysms (AAAs). No studies have compared circulating levels of MMPs after endovascular graft (EVG) exclusion in comparison with open surgical repair (OSR) in patients affected by AAA. METHODS AND RESULTS: An abdominal angiography and CT scan were performed in all patients at the time of enrollment. A spiral CT scan was performed at 6 months to detect presence of endoleaks. MMP-3 and MMP-9 levels were measured before EVG (n=30) and OSR (n=15) treatments and at 1, 3, and 6 months of follow-up by a sandwich ELISA technique. Healthy volunteers (n=10) were used as control subjects. Immunohistochemical staining for MMP-9 and MMP-3 was performed on tissue samples from surgical cases. Both MMP-9 and MMP-3 mean basal levels were significantly higher in patients affected by AAA than in control subjects (32.3+/-20.7 ng/mL for EVG and 28+/-9.9 ng/mL for OSR versus 8.9+/-2.5 ng/mL, 2P<0.05; 18.3+/-9.7 ng/mL and 26.7+/-10.8 ng/mL versus 8.2+/-5.3 ng/mL, 2P<0.001). In the OSR group, both MMP-9 and MMP-3 mean levels decreased after surgery (28+/-9.9 ng/mL at basal versus 14.7+/-6.6 ng/mL at 6 months, 2P<0.001; 26.7+/-10.8 versus 12+/-5.3 ng/mL; 2P<0.001). In the EVG group, a statistically significant difference at 6-month follow-up in MMP-9 and MMP-3 mean plasma values was detected in patients who had endoleakage in comparison with patients without endoleakage (44.3+/-20.7 versus 14.6+/-7.0 ng/mL, 2P<0.005; 25+/-11.5 versus 10.3+/-5.4 ng/mL, 2P<0.005). CONCLUSIONS: After EVG exclusion, MMP-9 and MMP-3 levels decreased to a level similar to that of patients undergoing OSR. In addition, a lack of decrease in MMP levels after EVG exclusion may help in identifying patients who will have endoleakage and consequent aneurysm expansion caused by continuous sac pressurization during follow-up.", "author" : [ { "dropping-particle" : "", "family" : "Sangiorgi", "given" : "G", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "D'Averio", "given" : "R", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Mauriello", "given" : "A", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Bondio", "given" : "M", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Pontillo", "given" : "M", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Castelvecchio", "given" : "S", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Trimarchi", "given" : "S", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Tolva", "given" : "V", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Nano", "given" : "G", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Rampoldi", "given" : "V", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Spagnoli", "given" : "L G", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Inglese", "given" : "L", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Circulation", "edition" : "2001/09/25", "id" : "ITEM-1", "issue" : "12 Suppl 1", "issued" : { "date-parts" : [ [ "2001" ] ] }, "language" : "eng", "note" : "Sangiorgi, G\nD'Averio, R\nMauriello, A\nBondio, M\nPontillo, M\nCastelvecchio, S\nTrimarchi, S\nTolva, V\nNano, G\nRampoldi, V\nSpagnoli, L G\nInglese, L\nClinical Trial\nComparative Study\nControlled Clinical Trial\nUnited States\nCirculation\nCirculation. 2001 Sep 18;104(12 Suppl 1):I288-95.", "page" : "I288-95", "title" : "Plasma levels of metalloproteinases-3 and -9 as markers of successful abdominal aortic aneurysm exclusion after endovascular graft treatment", "type" : "article-journal", "volume" : "104" }, "uris" : [ "http://www.mendeley.com/documents/?uuid=2e25b2d9-ab03-48e5-8796-381d107c9c34" ] } ], "mendeley" : { "formattedCitation" : "88", "plainTextFormattedCitation" : "88", "previouslyFormattedCitation" : "88" }, "properties" : { }, "schema" : "https://github.com/citation-style-language/schema/raw/master/csl-citation.json" }88 leucocyte elastase/antitrypsin complex, D-dimers,ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "S0741-5214(01)34657-8 [pii] 10.1067/mva.2001.119040", "ISBN" : "0741-5214 (Print) 0741-5214 (Linking)", "PMID" : "11668313", "abstract" : "OBJECTIVE: Three proteolytic systems seem involved in the aneurysmal degradation of the aortic wall. Plasmin is a common activator of the systems and could thus be predictive for the progression of abdominal aortic aneurysms (AAAs). METHODS AND MATERIALS: In 1994, 112 of 141 male patients with AAA diagnosed through population screening (defined as 3 cm or more) were interviewed and examined and had blood samples taken. One hundred twelve cases were scanned annually for 1 to 5 years (mean, 2.5 years) and referred for surgery if the AAA exceeded 5 cm in diameter. A random sample of 70 of the 112 cases had P-plasmin-antiplasmin-complexes (PAPs), P-plasminogen, and S-elastin-peptides (SEPs). RESULTS: PAP was positively correlated with annual expansion rate (r = 0.39, 0.16-0.56), persisting after adjustment for initial AAA size, SEP, age, and smoking. However, PAP levels did not correlate with the initial AAA size or SEP. Furthermore, PAP levels were significantly predictive for cases expanding to operation-recommendable AAA sizes. Combined with the initial AAA size, both optimal sensitivity and specificity were 82%, increasing to 95% and 96%, respectively, excluding those lost to follow-up and accepting 2 mm of interobserver variation. CONCLUSION: The progression of AAA is correlated with the PAP level, which seems to have a predictive value similar to the best serologic predictor known, serum-elastin-peptides.", "author" : [ { "dropping-particle" : "", "family" : "Lindholt", "given" : "J S", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Jorgensen", "given" : "B", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Fasting", "given" : "H", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Henneberg", "given" : "E W", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "J Vasc Surg", "edition" : "2001/10/23", "id" : "ITEM-1", "issue" : "4", "issued" : { "date-parts" : [ [ "2001" ] ] }, "language" : "eng", "note" : "Lindholt, J S\nJorgensen, B\nFasting, H\nHenneberg, E W\nResearch Support, Non-U.S. Gov't\nValidation Studies\nUnited States\nJournal of vascular surgery\nJ Vasc Surg. 2001 Oct;34(4):611-5.", "page" : "611-615", "title" : "Plasma levels of plasmin-antiplasmin-complexes are predictive for small abdominal aortic aneurysms expanding to operation-recommendable sizes", "type" : "article-journal", "volume" : "34" }, "uris" : [ "http://www.mendeley.com/documents/?uuid=0242ce4f-e17f-4abb-b198-5a655ed1279e" ] } ], "mendeley" : { "formattedCitation" : "89", "plainTextFormattedCitation" : "89", "previouslyFormattedCitation" : "89" }, "properties" : { }, "schema" : "https://github.com/citation-style-language/schema/raw/master/csl-citation.json" }89 and degradation products of ECM.
[H3] Calcification
Calcifications appear very early in the evolution of aortic atherothrombosis and AAAs.
Precipitation of ionized calcium in soft tissue depends on the presence of inorganic phosphates. Sources of inorganic phosphates in arterial tissue are intracellular energy metabolism (ATP recycling), extracellular (lipoproteins) or cell membrane phospholipids, free extracellular DNA and from the action of alkaline phosphatase. Free DNA provides sites for calcium precipitation on the backbone phosphates. This has been observed in the AAA wall, potentially associated with v-SMC death and release of free DNA.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1016/j.atherosclerosis.2017.03.005", "ISBN" : "1879-1484 (Electronic)\r0021-9150 (Linking)", "PMID" : "28292668", "abstract" : "BACKGROUND AND AIMS: The arterial wall calcium score and circulating free DNA levels are now used in clinical practice as biomarkers of cardiovascular risk. Calcium phosphate apatite retention in the arterial wall necessitates precipitation on an anionic platform. Here, we explore the role of tissue-free DNA as such a platform. METHODS: The first step consisted of histological observation of samples from human and rat calcified arteries. Various stains were used to evaluate colocalization of free DNA with calcified tissue (alizarin red, fluorescent Hoechst, DNA immunostaining and TUNEL assay). Sections were treated by EDTA to reveal calcification background. Secondly, a rat model of vascular calcifications induced by intra-aortic infusions of free DNA and elastase + free DNA was developed. Rat aortas underwent a micro-CT for calcium score calculation at 3 weeks. Rat and human calcifications were qualitatively characterized using muFourier Transform Infrared Spectroscopy (muFTIR) and Field Emission-Scanning Electron Microscopy (FE-SEM). RESULTS: Our histological study shows colocalization of calcified arterial plaques with free DNA. In the intra-aortic infusion model, free DNA was able to penetrate into the arterial wall and induce calcifications whereas no microscopic calcification was seen in control aortas. The calcification score in the elastase + free DNA group was significantly higher than in the control groups. Qualitative evaluation with muFTIR and FE-SEM demonstrated typical calcium phosphate retention in human and rat arterial specimens. CONCLUSIONS: This translational study demonstrates that free DNA could be involved in arterial calcification formation by precipitating calcium phosphate apatite crystals in the vessel wall.", "author" : [ { "dropping-particle" : "", "family" : "Coscas", "given" : "R", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Bensussan", "given" : "M", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Jacob", "given" : "M P", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Louedec", "given" : "L", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Massy", "given" : "Z", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Sadoine", "given" : "J", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Daudon", "given" : "M", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Chaussain", "given" : "C", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Bazin", "given" : "D", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Michel", "given" : "J B", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Atherosclerosis", "id" : "ITEM-1", "issued" : { "date-parts" : [ [ "2017" ] ] }, "note" : "Coscas, Raphael\nBensussan, Marie\nJacob, Marie-Paule\nLouedec, Liliane\nMassy, Ziad\nSadoine, Jeremy\nDaudon, Michel\nChaussain, Catherine\nBazin, Dominique\nMichel, Jean-Baptiste\neng\nIreland\n2017/03/16 06:00\nAtherosclerosis. 2017 Apr;259:60-67. doi: 10.1016/j.atherosclerosis.2017.03.005. Epub 2017 Mar 4.", "page" : "60-67", "title" : "Free DNA precipitates calcium phosphate apatite crystals in the arterial wall in vivo", "type" : "article-journal", "volume" : "259" }, "uris" : [ "http://www.mendeley.com/documents/?uuid=52272080-f4c5-420f-8a65-6d461539a81a" ] } ], "mendeley" : { "formattedCitation" : "100", "plainTextFormattedCitation" : "100", "previouslyFormattedCitation" : "100" }, "properties" : { }, "schema" : "https://github.com/citation-style-language/schema/raw/master/csl-citation.json" }100 There is conflicting evidence about the role of the aneurysmal aortic wall calcification on disease progression.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1016/j.atherosclerosis.2007.03.012", "ISBN" : "1879-1484 (Electronic)\r0021-9150 (Linking)", "PMID" : "17442319", "abstract" : "BACKGROUND: The biomechanical properties of the abdominal aortic aneurysm (AAA) wall may hold predictive potential. This study aims to study the potential role of wall calcification in small AAAs. METHODS: Initial AAA calcification was determined by ultrasonography to be either more or less than 50% of the initial maximal AAA circumference in 122 men with an initial AAA sized 30-49 mm in maximal diameter. The patients were offered annual control scans and refered for surgery, if the AAA diameter exceeded 50 mm. Surgery for AAA from the date of inclusion to 15 March 2005 was identified in the national vascular registry \"Karbase\". Mean follow time was 6.15 years. RESULTS: The mean annual growth rate was significantly lower in men with an AAA wall calcification above than below 50% (1.72 mm versus 2.97 mm, P=0.001). The finding persisted after multivariate linear regression analysis adjusting for age, smoking and aspirin use. A total of 12 men with AAA calcification above 50% were operated compared with 25 men with an AAA calcification below 50% (risk ratio: 0.35 (0.18-0.71), P=0.003). The difference in risk persisted after adjustment for age, smoking and use of aspirin (risk ratio: 0.36 (0.18-0.74), P=0.008). CONCLUSION: The calcification content in small AAA predicts the natural history of small AAA.", "author" : [ { "dropping-particle" : "", "family" : "Lindholt", "given" : "J S", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Atherosclerosis", "id" : "ITEM-1", "issue" : "2", "issued" : { "date-parts" : [ [ "2008" ] ] }, "note" : "Lindholt, Jes S\neng\nResearch Support, Non-U.S. Gov't\nIreland\n2007/04/20 09:00\nAtherosclerosis. 2008 Apr;197(2):673-8. doi: 10.1016/j.atherosclerosis.2007.03.012. Epub 2007 Apr 17.", "page" : "673-678", "title" : "Aneurysmal wall calcification predicts natural history of small abdominal aortic aneurysms", "type" : "article-journal", "volume" : "197" }, "uris" : [ "http://www.mendeley.com/documents/?uuid=bd04599e-e029-4e90-a4c5-66e8666bff5b" ] }, { "id" : "ITEM-2", "itemData" : { "DOI" : "10.1016/j.ejvs.2013.09.006", "ISSN" : "10785884", "PMID" : "24091093", "abstract" : "OBJECTIVES Abdominal aortic aneurysm (AAA) is a major cause of death in developed countries. The AAA diameter is still the only validated prognostic measure for rupture, and therapeutic interventions are initiated accordingly. This still leads to unnecessary interventions in some cases or unidentified impending ruptures. Vascular calcification has been validated abundantly as a risk factor in the cardiovascular field and may strengthen the rupture risk assessment of the AAA. With this study we aim to assess the correlation between AAA calcification and rupture risk in a retrospective unmatched case-control population. METHODS A database of 334 AAA patients was evaluated. Three groups were formed: elective (eAAA; n = 233), ruptured (rAAA; n = 73) and symptomatic non-ruptured (sAAA; n = 28) AAA patients. The Abdominal Aortic Calcification-8 score (AAC-8) was used to measure the severity of vascular calcification. RESULTS The AAA diameter (61 \u00b1 12 mm vs. 74 \u00b1 21 mm; p < .001) and AAC-8 score (3.4 \u00b1 2 points vs. 4.9 \u00b1 2.3 points; p < .001) of the eAAA and the combined rAAA and sAAA groups, respectively, were significantly different after univariate analysis. Multivariate analysis showed that larger AAA diameter (odds ratio [OR]: 1.048/mm increase; 95% confidence interval [CI]: 1.042-1.082; p < .001) and a higher AAC-8 score (OR: 1.34/point increase; 95% CI: 1.19-1.53; p < .001) were significantly associated with development into a sAAA or rAAA. Peripheral artery disease was significantly correlated to eventual elective treatment (OR: 0.39; 95% CI: .15-1; p = .049). CONCLUSION This study suggests a trend of an increased degree of calcification in symptomatic or even ruptured AAA patients compared with elective AAA patients.", "author" : [ { "dropping-particle" : "", "family" : "Buijs", "given" : "R.V.C.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Willems", "given" : "T.P.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Tio", "given" : "R.A.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Boersma", "given" : "H.H.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Tielliu", "given" : "I.F.J.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Slart", "given" : "R.H.J.A.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Zeebregts", "given" : "C.J.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "European Journal of Vascular and Endovascular Surgery", "id" : "ITEM-2", "issue" : "5", "issued" : { "date-parts" : [ [ "2013", "11" ] ] }, "page" : "542-548", "title" : "Calcification as a Risk Factor for Rupture of Abdominal Aortic Aneurysm", "type" : "article-journal", "volume" : "46" }, "uris" : [ "http://www.mendeley.com/documents/?uuid=e63166ae-a3f1-3bdb-b495-2085fb27d0f1" ] } ], "mendeley" : { "formattedCitation" : "101,102", "plainTextFormattedCitation" : "101,102", "previouslyFormattedCitation" : "101,102" }, "properties" : { }, "schema" : "https://github.com/citation-style-language/schema/raw/master/csl-citation.json" }101,102
[H2] Innate and adaptive immunity
Under physiological conditions, the media of the aorta is an avascular tissue, and an immune-privileged site devoid of capillaries. Therefore, the diapedesis (the passage of blood cells through the intact walls of the capillaries) of circulating leukocytes in the media depends on neo-angiogenesis.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "ATVBAHA.106.137851 [pii] 10.1161/ATVBAHA.106.137851", "ISBN" : "1524-4636 (Electronic) 1079-5642 (Linking)", "PMID" : "17395854", "abstract" : "Arteries are composed of 3 concentric tissue layers which exhibit different structures and properties. Because arterial injury is generally initiated at the interface with circulating blood, most studies performed to unravel the mechanisms involved in injury-induced arterial responses have focused on the innermost layer (intima) rather than on the outermost adventitial layer. In the present review, we focus on the involvement of the adventitia in response to various types of arterial injury leading to vascular remodeling. Physiologically, soluble vascular mediators are centrifugally conveyed by mass transport toward the adventitia. Moreover, in pathological conditions, neomediators and antigens can be generated within the arterial wall, whose outward conveyance triggers different patterns of local adventitial response. Adventitial angiogenesis, immunoinflammation, and fibrosis sequentially interact and their net balance defines the participation of the adventitial response in arterial pathology. In the present review we discuss 4 pathological entities in which the adventitial response to arterial wall injury participates in arterial wall remodeling. Hence, the adventitial adaptive immune response predominates in chronic rejection. Inflammatory phagocytic cell recruitment and initiation of a shift from innate to adaptive immunity characterize the adventitial response to products of proteolysis in abdominal aortic aneurysm. Adventitial sprouting of neovessels, leading to intraplaque hemorrhages, predominates in atherothrombosis. Adventitial fibrosis characterizes the response to mechanical stress and is responsible for the constrictive remodeling of arterial segments and initiating interstitial fibrosis in perivascular tissues. These adventitial events, therefore, have an impact not only on the vessel wall biology but also on the surrounding tissue.", "author" : [ { "dropping-particle" : "", "family" : "Michel", "given" : "J B", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Thaunat", "given" : "O", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Houard", "given" : "X", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Meilhac", "given" : "O", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Caligiuri", "given" : "G", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Nicoletti", "given" : "A", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Arterioscler Thromb Vasc Biol", "edition" : "2007/03/31", "id" : "ITEM-1", "issue" : "6", "issued" : { "date-parts" : [ [ "2007" ] ] }, "language" : "eng", "note" : "Michel, Jean-Baptiste\nThaunat, Olivier\nHouard, Xavier\nMeilhac, Olivier\nCaligiuri, Giuseppina\nNicoletti, Antonino\nResearch Support, Non-U.S. Gov't\nReview\nUnited States\nArteriosclerosis, thrombosis, and vascular biology\nArterioscler Thromb Vasc Biol. 2007 Jun;27(6):1259-68. Epub 2007 Mar 29.", "page" : "1259-1268", "title" : "Topological determinants and consequences of adventitial responses to arterial wall injury", "type" : "article-journal", "volume" : "27" }, "uris" : [ "http://www.mendeley.com/documents/?uuid=17770592-56d5-43e8-9569-a32e053b1a00" ] } ], "mendeley" : { "formattedCitation" : "82", "plainTextFormattedCitation" : "82", "previouslyFormattedCitation" : "82" }, "properties" : { }, "schema" : "https://github.com/citation-style-language/schema/raw/master/csl-citation.json" }82 In contrast, the external adventitia of the aorta is fully vascularised, allowing leukocyte diapedesis, innate and adaptive immunity and inward sprouting of new vessels in response to growth factors.
Bacteria circulating in vessels have a high affinity for thrombi. In AAAs, ILT fosters compartmentalization of pathogens and promotes local innate immunity.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1371/journal.pone.0018679", "ISBN" : "1932-6203 (Electronic) 1932-6203 (Linking)", "PMID" : "21533243", "abstract" : "BACKGROUND: Abdominal Aortic Aneurysms (AAAs) represent a particular form of atherothrombosis where neutrophil proteolytic activity plays a major role. We postulated that neutrophil recruitment and activation participating in AAA growth may originate in part from repeated episodes of periodontal bacteremia. METHODS AND FINDINGS: Our results show that neutrophil activation in human AAA was associated with Neutrophil Extracellular Trap (NET) formation in the IntraLuminal Thrombus, leading to the release of cell-free DNA. Human AAA samples were shown to contain bacterial DNA with high frequency (11/16), and in particular that of Porphyromonas gingivalis (Pg), the most prevalent pathogen involved in chronic periodontitis, a common form of periodontal disease. Both DNA reflecting the presence of NETs and antibodies to Pg were found to be increased in plasma of patients with AAA. Using a rat model of AAA, we demonstrated that repeated injection of Pg fostered aneurysm development, associated with pathological characteristics similar to those observed in humans, such as the persistence of a neutrophil-rich luminal thrombus, not observed in saline-injected rats in which a healing process was observed. CONCLUSIONS: Thus, the control of periodontal disease may represent a therapeutic target to limit human AAA progression.", "author" : [ { "dropping-particle" : "", "family" : "Delbosc", "given" : "S", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Alsac", "given" : "J M", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Journe", "given" : "C", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Louedec", "given" : "L", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Castier", "given" : "Y", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Bonnaure-Mallet", "given" : "M", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Ruimy", "given" : "R", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Rossignol", "given" : "P", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Bouchard", "given" : "P", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Michel", "given" : "J B", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Meilhac", "given" : "O", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "PLoS One", "edition" : "2011/05/03", "id" : "ITEM-1", "issue" : "4", "issued" : { "date-parts" : [ [ "2011" ] ] }, "language" : "eng", "note" : "Delbosc, Sandrine\nAlsac, Jean-Marc\nJourne, Clement\nLouedec, Liliane\nCastier, Yves\nBonnaure-Mallet, Martine\nRuimy, Raymond\nRossignol, Patrick\nBouchard, Philippe\nMichel, Jean-Baptiste\nMeilhac, Olivier\nResearch Support, Non-U.S. Gov't\nUnited States\nPloS one\nPLoS One. 2011 Apr 13;6(4):e18679. doi: 10.1371/journal.pone.0018679.", "page" : "e18679", "title" : "Porphyromonas gingivalis participates in pathogenesis of human abdominal aortic aneurysm by neutrophil activation. Proof of concept in rats", "type" : "article-journal", "volume" : "6" }, "uris" : [ "http://www.mendeley.com/documents/?uuid=a9d9fba3-d55f-43fc-8d69-89129420d6dc" ] } ], "mendeley" : { "formattedCitation" : "95", "plainTextFormattedCitation" : "95", "previouslyFormattedCitation" : "95" }, "properties" : { }, "schema" : "https://github.com/citation-style-language/schema/raw/master/csl-citation.json" }95 This introduces Neutrophil Extracellular Traps, able to retain proteases and oxidant molecules, and eventually will enhance aneurysmal growth and risk of rupture. Therefore bacterial trapping is a potential biological process fostering the AAA growth and rupture.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1371/journal.pone.0018679", "ISBN" : "1932-6203 (Electronic) 1932-6203 (Linking)", "PMID" : "21533243", "abstract" : "BACKGROUND: Abdominal Aortic Aneurysms (AAAs) represent a particular form of atherothrombosis where neutrophil proteolytic activity plays a major role. We postulated that neutrophil recruitment and activation participating in AAA growth may originate in part from repeated episodes of periodontal bacteremia. METHODS AND FINDINGS: Our results show that neutrophil activation in human AAA was associated with Neutrophil Extracellular Trap (NET) formation in the IntraLuminal Thrombus, leading to the release of cell-free DNA. Human AAA samples were shown to contain bacterial DNA with high frequency (11/16), and in particular that of Porphyromonas gingivalis (Pg), the most prevalent pathogen involved in chronic periodontitis, a common form of periodontal disease. Both DNA reflecting the presence of NETs and antibodies to Pg were found to be increased in plasma of patients with AAA. Using a rat model of AAA, we demonstrated that repeated injection of Pg fostered aneurysm development, associated with pathological characteristics similar to those observed in humans, such as the persistence of a neutrophil-rich luminal thrombus, not observed in saline-injected rats in which a healing process was observed. CONCLUSIONS: Thus, the control of periodontal disease may represent a therapeutic target to limit human AAA progression.", "author" : [ { "dropping-particle" : "", "family" : "Delbosc", "given" : "S", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Alsac", "given" : "J M", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Journe", "given" : "C", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Louedec", "given" : "L", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Castier", "given" : "Y", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Bonnaure-Mallet", "given" : "M", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Ruimy", "given" : "R", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Rossignol", "given" : "P", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Bouchard", "given" : "P", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Michel", "given" : "J B", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Meilhac", "given" : "O", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "PLoS One", "edition" : "2011/05/03", "id" : "ITEM-1", "issue" : "4", "issued" : { "date-parts" : [ [ "2011" ] ] }, "language" : "eng", "note" : "Delbosc, Sandrine\nAlsac, Jean-Marc\nJourne, Clement\nLouedec, Liliane\nCastier, Yves\nBonnaure-Mallet, Martine\nRuimy, Raymond\nRossignol, Patrick\nBouchard, Philippe\nMichel, Jean-Baptiste\nMeilhac, Olivier\nResearch Support, Non-U.S. Gov't\nUnited States\nPloS one\nPLoS One. 2011 Apr 13;6(4):e18679. doi: 10.1371/journal.pone.0018679.", "page" : "e18679", "title" : "Porphyromonas gingivalis participates in pathogenesis of human abdominal aortic aneurysm by neutrophil activation. Proof of concept in rats", "type" : "article-journal", "volume" : "6" }, "uris" : [ "http://www.mendeley.com/documents/?uuid=a9d9fba3-d55f-43fc-8d69-89129420d6dc" ] } ], "mendeley" : { "formattedCitation" : "94", "plainTextFormattedCitation" : "94", "previouslyFormattedCitation" : "94" }, "properties" : { }, "schema" : "https://github.com/citation-style-language/schema/raw/master/csl-citation.json" }94 Bacterial infection can also cause a subtype of AAA, called mycotic AAA (Box 1). AAA progression involves both innate and adaptive immunity. [Innate immune activities involve the diapedesis of PMN in the ILT, mainly by interaction with activated platelets, exposing P-selectin, the ligand of PSGL-1 expressed on neutrophils and the phagocytic (macrophage) activities in the adventitia. PMN activation and death results in a release of granule contents, including proteases, oxidant peptides, myeloperoxidase and pro-inflammatory mediators, such as IL-8.
The outward radial convection of degradation products and mediators, results in endocytosis whilst phagocytosis mainly takes place in the inner adventitia. The principal phagocytic activity detected is the storage of ferric iron from RBC within CD68 positive cells (CD68 is a specific marker of phagocytic functions, but not of a cell lineage). All cells with phagocytic activities acquire the CD 68 hallmark of phagolysosome fusion, including macrophages and VSMC. Ferric iron deposits can also be observed in peri-aortic lymph nodes.
The inner layer of the adventitia is the preferred, and commonly the only, site for the development of intense neo-angiogenesis. In the AAA context, relative hypoxia and phospholipid metabolism producing eicosanoids, could trigger neo-angiogenesis by induction of VEGF overexpression in macrophages and vSMC This neo-angiogenesis includes dense arterioles, capillaries, venules and lymphatic vessels.
Adaptive immune responses to the proteolytic and/or oxidative injuries of the wall also take place in the adventitia.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "ATVBAHA.106.137851 [pii] 10.1161/ATVBAHA.106.137851", "ISBN" : "1524-4636 (Electronic) 1079-5642 (Linking)", "PMID" : "17395854", "abstract" : "Arteries are composed of 3 concentric tissue layers which exhibit different structures and properties. Because arterial injury is generally initiated at the interface with circulating blood, most studies performed to unravel the mechanisms involved in injury-induced arterial responses have focused on the innermost layer (intima) rather than on the outermost adventitial layer. In the present review, we focus on the involvement of the adventitia in response to various types of arterial injury leading to vascular remodeling. Physiologically, soluble vascular mediators are centrifugally conveyed by mass transport toward the adventitia. Moreover, in pathological conditions, neomediators and antigens can be generated within the arterial wall, whose outward conveyance triggers different patterns of local adventitial response. Adventitial angiogenesis, immunoinflammation, and fibrosis sequentially interact and their net balance defines the participation of the adventitial response in arterial pathology. In the present review we discuss 4 pathological entities in which the adventitial response to arterial wall injury participates in arterial wall remodeling. Hence, the adventitial adaptive immune response predominates in chronic rejection. Inflammatory phagocytic cell recruitment and initiation of a shift from innate to adaptive immunity characterize the adventitial response to products of proteolysis in abdominal aortic aneurysm. Adventitial sprouting of neovessels, leading to intraplaque hemorrhages, predominates in atherothrombosis. Adventitial fibrosis characterizes the response to mechanical stress and is responsible for the constrictive remodeling of arterial segments and initiating interstitial fibrosis in perivascular tissues. These adventitial events, therefore, have an impact not only on the vessel wall biology but also on the surrounding tissue.", "author" : [ { "dropping-particle" : "", "family" : "Michel", "given" : "J B", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Thaunat", "given" : "O", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Houard", "given" : "X", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Meilhac", "given" : "O", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Caligiuri", "given" : "G", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Nicoletti", "given" : "A", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Arterioscler Thromb Vasc Biol", "edition" : "2007/03/31", "id" : "ITEM-1", "issue" : "6", "issued" : { "date-parts" : [ [ "2007" ] ] }, "language" : "eng", "note" : "Michel, Jean-Baptiste\nThaunat, Olivier\nHouard, Xavier\nMeilhac, Olivier\nCaligiuri, Giuseppina\nNicoletti, Antonino\nResearch Support, Non-U.S. Gov't\nReview\nUnited States\nArteriosclerosis, thrombosis, and vascular biology\nArterioscler Thromb Vasc Biol. 2007 Jun;27(6):1259-68. Epub 2007 Mar 29.", "page" : "1259-1268", "title" : "Topological determinants and consequences of adventitial responses to arterial wall injury", "type" : "article-journal", "volume" : "27" }, "uris" : [ "http://www.mendeley.com/documents/?uuid=17770592-56d5-43e8-9569-a32e053b1a00" ] } ], "mendeley" : { "formattedCitation" : "82", "plainTextFormattedCitation" : "82", "previouslyFormattedCitation" : "82" }, "properties" : { }, "schema" : "https://github.com/citation-style-language/schema/raw/master/csl-citation.json" }82 This immune response is characterized by the development of Tertiary Lymphoid Organs (ATLO), an organized lymphocytic neo-granuloma with a germinal centre constituted of B-cells, able to mature the adaptive immune response toward antibody production. These germinal centres are surrounded by endothelial venules, follicular dentritic cells, and T follicular helper cells, which stimulate immunoglobulin switching through a specific and complex cytokine network.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1161/CIRCULATIONAHA.114.010988", "ISBN" : "1524-4539 (Electronic)\r0009-7322 (Linking)", "PMID" : "25552357", "abstract" : "BACKGROUND: The atheromodulating activity of B cells during the development of atherosclerosis is well documented, but the mechanisms by which these cells are regulated have not been investigated. METHODS AND RESULTS: Here, we analyzed the contribution of Qa-1-restricted CD8(+) regulatory T cells to the control of the T follicular helper-germinal center B-cell axis during atherogenesis. Genetic disruption of CD8(+) regulatory T cell function in atherosclerosis-prone apolipoprotein E knockout mice resulted in overactivation of this axis in secondary lymphoid organs, led to the increased development of tertiary lymphoid organs in the aorta, and enhanced disease development. In contrast, restoring control of the T follicular helper-germinal center B-cell axis by blocking the ICOS-ICOSL pathway reduced the development of atherosclerosis and the formation of tertiary lymphoid organs. Moreover, analyses of human atherosclerotic aneurysmal arteries by flow cytometry, gene expression analysis, and immunofluorescence confirmed the presence of T follicular helper cells within tertiary lymphoid organs. CONCLUSIONS: This study is the first to demonstrate that the T follicular helper-germinal center B-cell axis is proatherogenic and that CD8(+) regulatory T cells control the germinal center reaction in both secondary and tertiary lymphoid organs. Therefore, disrupting this axis represents an innovative therapeutic approach.", "author" : [ { "dropping-particle" : "", "family" : "Clement", "given" : "M", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Guedj", "given" : "K", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Andreata", "given" : "F", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Morvan", "given" : "M", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Bey", "given" : "L", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Khallou-Laschet", "given" : "J", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Gaston", "given" : "A T", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Delbosc", "given" : "S", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Alsac", "given" : "J M", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Bruneval", "given" : "P", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Deschildre", "given" : "C", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Borgne", "given" : "M", "non-dropping-particle" : "Le", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Castier", "given" : "Y", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Kim", "given" : "H J", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Cantor", "given" : "H", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Michel", "given" : "J B", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Caligiuri", "given" : "G", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Nicoletti", "given" : "A", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Circulation", "id" : "ITEM-1", "issue" : "6", "issued" : { "date-parts" : [ [ "2015" ] ] }, "note" : "Clement, Marc\nGuedj, Kevin\nAndreata, Francesco\nMorvan, Marion\nBey, Laetitia\nKhallou-Laschet, Jamila\nGaston, Anh-Thu\nDelbosc, Sandrine\nAlsac, Jean-Marc\nBruneval, Patrick\nDeschildre, Catherine\nLe Borgne, Marie\nCastier, Yves\nKim, Hye-Jung\nCantor, Harvey\nMichel, Jean-Baptiste\nCaligiuri, Giuseppina\nNicoletti, Antonino\neng\nResearch Support, Non-U.S. Gov't\n2015/01/02 06:00\nCirculation. 2015 Feb 10;131(6):560-70. doi: 10.1161/CIRCULATIONAHA.114.010988. Epub 2014 Dec 31.", "page" : "560-570", "title" : "Control of the T follicular helper-germinal center B-cell axis by CD8(+) regulatory T cells limits atherosclerosis and tertiary lymphoid organ development", "type" : "article-journal", "volume" : "131" }, "uris" : [ "http://www.mendeley.com/documents/?uuid=77d1205c-8ca9-4583-9576-498f830cd0d6" ] } ], "mendeley" : { "formattedCitation" : "97", "plainTextFormattedCitation" : "97", "previouslyFormattedCitation" : "97" }, "properties" : { }, "schema" : "https://github.com/citation-style-language/schema/raw/master/csl-citation.json" }97 This adaptive immune response depends on two main conditions: a specific inter-T cell and interleukin network able to organize the lymphoid organ structure, and outwardly convected neo-antigens able to drive antibody maturation. Neo-antigens are self-molecules, transformed by oxidation or by proteolysis, revealing new modified epitopes that could stimulate the immune system. The cumulative response is that ATLO produce polyspecific antibodies, directed against neo-antigens which have proteolytic or oxidative modifications (FIG. 5). There is no direct retro-diffusion of antibodies to the media or the ILT, they are recycled into the general circulation and reach their molecular targets from the plasma.
There are important data which provide evidence that complement pathways are activated in AAA.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1161/ATVBAHA.112.301191", "ISBN" : "1524-4636 (Electronic)\r1079-5642 (Linking)", "PMID" : "23702661", "abstract" : "OBJECTIVE: To identify proteins related to intraluminal thrombus biological activities that could help to find novel pathological mechanisms and therapeutic targets for human abdominal aortic aneurysm (AAA). APPROACH AND RESULTS: Tissue-conditioned media from patients with AAA were analyzed by a mass spectrometry-based strategy using liquid chromatography coupled to tandem mass spectrometry. Global pathway analysis by Ingenuity software highlighted the presence of several circulating proteins, among them were proteins from the complement system. Complement C3 concentration and activation were assessed in plasma from AAA patients (small AAA, AAA diameter=3-5 cm and large AAA, AAA diameter >5 cm), showing decreased C3 levels and activation in large AAA patients. No association of a combination of single-nucleotide polymorphisms in complement genes between large and small AAA patients was observed. Intense extracellular C3 inmunostaining, along with C9, was observed in AAA thrombus. Analysis of C3 in AAA tissue homogenates and tissue-conditioned media showed increased levels of C3 in AAA thrombus, as well as proteolytic fragments (C3a/C3c/C3dg), suggesting its local deposition and activation. Finally, the functional role of local complement activation in polymorphonuclear (PMN) cell activation was tested, showing that C3 blockade by anti-C3 antibody was able to decrease thrombus-induced neutrophil chemotaxis and reactive oxygen species production. CONCLUSIONS: A decrease of systemic C3 concentration and activity in the later stages of AAA associated with local complement retention, consumption, and proteolysis in the thrombus could induce PMN chemotaxis and activation, playing a detrimental role in AAA progression.", "author" : [ { "dropping-particle" : "", "family" : "Martinez-Pinna", "given" : "R", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Madrigal-Matute", "given" : "J", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Tarin", "given" : "C", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Burillo", "given" : "E", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Esteban-Salan", "given" : "M", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Pastor-Vargas", "given" : "C", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Lindholt", "given" : "J S", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Lopez", "given" : "J A", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Calvo", "given" : "E", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "V", "family" : "Ceniga", "given" : "M", "non-dropping-particle" : "de", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Meilhac", "given" : "O", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Egido", "given" : "J", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Blanco-Colio", "given" : "L M", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Michel", "given" : "J B", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Martin-Ventura", "given" : "J L", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Arterioscler Thromb Vasc Biol", "id" : "ITEM-1", "issue" : "8", "issued" : { "date-parts" : [ [ "2013" ] ] }, "note" : "Martinez-Pinna, Roxana\nMadrigal-Matute, Julio\nTarin, Carlos\nBurillo, Elena\nEsteban-Salan, Margarita\nPastor-Vargas, Carlos\nLindholt, Jes S\nLopez, Juan A\nCalvo, Enrique\nde Ceniga, Melina Vega\nMeilhac, Olivier\nEgido, Jesus\nBlanco-Colio, Luis M\nMichel, Jean-Baptiste\nMartin-Ventura, Jose L\neng\nResearch Support, Non-U.S. Gov't\n2013/05/25 06:00\nArterioscler Thromb Vasc Biol. 2013 Aug;33(8):2013-20. doi: 10.1161/ATVBAHA.112.301191. Epub 2013 May 23.", "page" : "2013-2020", "title" : "Proteomic analysis of intraluminal thrombus highlights complement activation in human abdominal aortic aneurysms", "type" : "article-journal", "volume" : "33" }, "uris" : [ "http://www.mendeley.com/documents/?uuid=48e4b95f-3209-46da-ad5b-b9f8ab74388d" ] } ], "mendeley" : { "formattedCitation" : "98", "plainTextFormattedCitation" : "98", "previouslyFormattedCitation" : "98" }, "properties" : { }, "schema" : "https://github.com/citation-style-language/schema/raw/master/csl-citation.json" }98 In man, molecular elements of the complement cascade predominate in the ILT. Nevertheless, the exact pathophysiology of complement activation in human AAA remains to be more clearly defined. Current data would support the hypothesis that adventitial immune adaptive response in AAA might be more than a bystander, but rather an active participant in AAA growth and rupture risk.
The adventitia of AAA is also enriched by mast cells containing tryptase and chymase, in relation to adventitial neo-angiogenesis.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1016/j.jvs.2009.03.055", "ISBN" : "1097-6809 (Electronic)\r0741-5214 (Linking)", "PMID" : "19515525", "abstract" : "OBJECTIVE: Mast cells (MCs) are inflammatory cells present in atherosclerotic lesions and neovascularized tissues. Recently, MCs were shown to modulate abdominal aortic aneurysm (AAA) formation in a mouse model. Progression of aneurysmatic disease process may also depend on intraluminal thrombus and neovascularization of the aneurysm wall. Here we investigated the relationship between MCs and inflammation, neovascularization, and the presence of intraluminal thrombus in human AAA. METHODS AND RESULTS: Specimens from AAAs and normal control aortas were analyzed with basic histology, immunohistochemical staining, and quantitative real-time polymerase chain reaction (PCR). Double immunostainings with endothelial cell markers CD31/CD34 and MC tryptase showed that, in contrast to histologically normal aorta, MCs in AAA were abundant in the media, but absent from the intima. Medial MCs and (CD31/CD34)(+) neovessels increased significantly in AAA compared with normal aorta (P < .0001 for both), and the highest densities of neovessels and MCs were observed in the media of thrombus-covered AAA samples. Also, the proportional thickness of aortic wall penetrated by the neovessels was significantly higher in the AAA samples (P < .0001), and the neovascularized area correlated with the density of medial MCs (P < .0001). In histologic analysis, the medial MCs were mainly located adjacent to the stem cell factor (SCF)(+) medial neovessels. Real-time PCR analysis also showed that mRNA levels of genes associated with neovascularization (vascular endothelial growth factor [VEGF], FLT1, VE-cadherin, CD31), and MCs (tryptase, chymase, cathepsin G) were higher in AAA samples than in controls. Demonstration of adhered platelets by CD42b staining and lack of endothelial cell (CD31/CD34) staining in the luminal surface of AAA specimens suggest endothelial erosion of the aneurysm walls. CONCLUSIONS: The results support participation of MCs in the pathogenesis of AAA, particularly regarding neovascularization of aortic wall.", "author" : [ { "dropping-particle" : "", "family" : "Mayranpaa", "given" : "M I", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Trosien", "given" : "J A", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Fontaine", "given" : "V", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Folkesson", "given" : "M", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Kazi", "given" : "M", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Eriksson", "given" : "P", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Swedenborg", "given" : "J", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Hedin", "given" : "U", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "J Vasc Surg", "id" : "ITEM-1", "issue" : "2", "issued" : { "date-parts" : [ [ "2009" ] ] }, "note" : "Mayranpaa, Mikko I\nTrosien, Julia A\nFontaine, Vincent\nFolkesson, Maggie\nKazi, Monsur\nEriksson, Per\nSwedenborg, Jesper\nHedin, Ulf\neng\nResearch Support, Non-U.S. Gov't\n2009/06/12 09:00\nJ Vasc Surg. 2009 Aug;50(2):388-95; discussion 395-6. doi: 10.1016/j.jvs.2009.03.055. Epub 2009 Jun 10.", "page" : "386-388", "title" : "Mast cells associate with neovessels in the media and adventitia of abdominal aortic aneurysms", "type" : "article-journal", "volume" : "50" }, "uris" : [ "http://www.mendeley.com/documents/?uuid=14ae058c-c90e-4d22-8c4d-9faa49ce6f48" ] } ], "mendeley" : { "formattedCitation" : "99", "plainTextFormattedCitation" : "99", "previouslyFormattedCitation" : "99" }, "properties" : { }, "schema" : "https://github.com/citation-style-language/schema/raw/master/csl-citation.json" }99 Mast cells are activated by IgE binding and clustering, which triggers degranulation, such as different vaso-active factors (serotonin, histamine, heparin, TNF, prostaglandins).
[H3] Inflammatory AAA
An inflammatory AAA is a clinical diagnosis based on thickened anterior and lateral aortic wall, confirmed in radiological examinations and seen during AAA repair operation.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "ISSN" : "0741-5214", "PMID" : "3880827", "abstract" : "This report concerns 30 patients with the acute form of \"inflammatory aneurysm\" of the aorta treated during a 27-year period between April 1957 and March 1984. There were 28 men and two women whose ages ranged from 46 to 78 years (most over 60 years). All were heavy smokers. The aneurysmal disease was located below the renal arteries and the inflammatory changes were limited to the abdomen in 24 patients; one patient had a ruptured aneurysm. The aneurysm involved the entire abdominal aorta in one, the descending thoracic and infrarenal abdominal aorta in two, and the descending thoracic and abdominal aorta in continuity in three patients. The inflammatory changes occurred grossly and microscopically in both abdominal and thoracic aortic segments in five of the latter six patients. The changes were manifested by anterior and lateral mural inflammatory thickening contiguous with similar changes of the retroperitoneum and mediastinum that produced varying degrees of ureteral obstruction in seven patients. Most had abdominal, back, or flank pain and abdominal tenderness, suggesting rupture or leakage. Emergency exploratory operation had been performed elsewhere in 10 patients. Operation was abandoned because of exposure difficulties, bowel perforation, or visceral arterial involvement. Diagnosis was suggested by CT scan in 10, ultrasonography in one, and excretory urograms in seven patients. Treatment consisted of thoracoabdominal aortic replacement in six and infrarenal aortic replacement in 24. The aorta was clamped at the diaphragm in most of the latter cases to avoid injury to adjacent structures. Nephrectomy or ureterolysis was rarely necessary. Of these 30 patients, 29 were early (30 day) survivors and ureteral obstruction spontaneously subsided in most cases without special treatment. There was one late death at 2 months and eight deaths from 3 to 13 years; 20 (67%) patients are still alive.", "author" : [ { "dropping-particle" : "", "family" : "Crawford", "given" : "J L", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Stowe", "given" : "C L", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Safi", "given" : "H J", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Hallman", "given" : "C H", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Crawford", "given" : "E S", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Journal of vascular surgery", "id" : "ITEM-1", "issue" : "1", "issued" : { "date-parts" : [ [ "1985", "1" ] ] }, "page" : "113-24", "title" : "Inflammatory aneurysms of the aorta.", "type" : "article-journal", "volume" : "2" }, "uris" : [ "http://www.mendeley.com/documents/?uuid=3c9c9b2c-1378-3140-9698-da40eb561aef" ] } ], "mendeley" : { "formattedCitation" : "106", "plainTextFormattedCitation" : "106", "previouslyFormattedCitation" : "106" }, "properties" : { }, "schema" : "https://github.com/citation-style-language/schema/raw/master/csl-citation.json" }106 The inflammatory reaction creates a close adhesion between the aortic wall and the neighboring organs: duodenum, small intestine, sigmoid, ureters and even rectum. The pathology of these aneurysms shows the dense fibrosis, densely infiltrated by lymphocytes.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "ISSN" : "0950-821X", "PMID" : "2009988", "abstract" : "Eight cases of inflammatory abdominal aortic aneurysm (IAAA) (group I) and a control group of ten cases of atherosclerotic abdominal aortic aneurysm (AAA) with little or no parietal inflammatory infiltrate (group II) were studied; using light microscopy, transmission electron microscopy (TEM), and immunohistochemistry. These were used to define cell composition in the inflammatory process, the degree of cell activation and alteration of connective tissue. Large numbers of B lymphocytes were present in IAAA with preservation of the T4/T8 ratio. In addition, HLA-DR and the IL2-R antigen (specific for activated cells) were widely expressed in the cell population. The interstitial matrix contained deposits of IgG, IgM and C3c together with an increase in type III collagen and a reduction in elastin which appeared fragmented and swollen. This study, therefore, characterised the cellular component of the parietal inflammatory infiltrate in IAAA. The degree of activation shown by these cell elements and the activation of complement suggest that the relevant antigen may have been localised in the aneurysm wall at the time of observation.", "author" : [ { "dropping-particle" : "", "family" : "Stella", "given" : "A", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Gargiulo", "given" : "M", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Pasquinelli", "given" : "G", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Preda", "given" : "P", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Faggioli", "given" : "G L", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Cenacchi", "given" : "G", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "D'Addato", "given" : "M", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "European journal of vascular surgery", "id" : "ITEM-1", "issue" : "1", "issued" : { "date-parts" : [ [ "1991", "2" ] ] }, "page" : "65-70", "title" : "The cellular component in the parietal infiltrate of inflammatory abdominal aortic aneurysms (IAAA).", "type" : "article-journal", "volume" : "5" }, "uris" : [ "http://www.mendeley.com/documents/?uuid=724eabcc-9e73-3f29-b576-25f7a4732fdd" ] } ], "mendeley" : { "formattedCitation" : "107", "plainTextFormattedCitation" : "107", "previouslyFormattedCitation" : "107" }, "properties" : { }, "schema" : "https://github.com/citation-style-language/schema/raw/master/csl-citation.json" }107
[H2] Oxidative stress
Oxidative stress is present in a tissue when the free radical production exceeds the capacity of the antioxidant defense. This imbalance leads to cell death, especially in endothelial cells, as a consequence of production of oxidized proteins, peroxides, and DNA damage.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "S0140-6736(05)66459-8 [pii] 10.1016/S0140-6736(05)66459-8 [doi]", "ISBN" : "1474-547X (Electronic) 0140-6736 (Linking)", "PMID" : "15866312", "abstract" : "Abdominal aortic aneurysms cause 1.3% of all deaths among men aged 65-85 years in developed countries. These aneurysms are typically asymptomatic until the catastrophic event of rupture. Repair of large or symptomatic aneurysms by open surgery or endovascular repair is recommended, whereas repair of small abdominal aortic aneurysms does not provide a significant benefit. Abdominal aortic aneurysm is linked to the degradation of the elastic media of the atheromatous aorta. An inflammatory cell infiltrate, neovascularisation, and production and activation of various proteases and cytokines contribute to the development of this disorder, although the underlying mechanisms are unknown. In this Seminar, we aim to provide an updated review of the pathophysiology, current and new diagnostic procedures, assessment, and treatment of abdominal aortic aneurysm to provide family practitioners with a working knowledge of this disorder.", "author" : [ { "dropping-particle" : "", "family" : "Sakalihasan", "given" : "N", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Limet", "given" : "R", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Defawe", "given" : "O D", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Lancet", "edition" : "2005/05/04", "id" : "ITEM-1", "issue" : "9470", "issued" : { "date-parts" : [ [ "2005" ] ] }, "language" : "eng", "note" : "Sakalihasan, N\nLimet, R\nDefawe, O D\nResearch Support, Non-U.S. Gov't\nReview\nEngland\nLancet\nLancet. 2005 Apr 30-May 6;365(9470):1577-89.", "page" : "1577-1589", "title" : "Abdominal aortic aneurysm", "type" : "article-journal", "volume" : "365" }, "uris" : [ "http://www.mendeley.com/documents/?uuid=0fcf1cfb-3c11-43fa-9d25-2c4a31838a62" ] } ], "mendeley" : { "formattedCitation" : "46", "plainTextFormattedCitation" : "46", "previouslyFormattedCitation" : "46" }, "properties" : { }, "schema" : "https://github.com/citation-style-language/schema/raw/master/csl-citation.json" }46 It also activates pro MMP2 and pro MMP9 that degrade the collagen fibres in the wall. Interestingly, smoking potentially acts by increasing oxidative stress. The two main sources of oxidative stress in human AAA are from PMN [nicotinamide adenine dinucleotide phosphate-oxidase (NADPH) and myeloperoxidase] and redox active iron released by trapped RBCs in the luminal layer of ILT.
Circulating HDL are dysfunctional in AAA patients, ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1093/cvr/cvt194", "ISBN" : "1755-3245 (Electronic)\r0008-6363 (Linking)", "PMID" : "23955602", "abstract" : "AIMS: Abdominal aortic aneurysm (AAA) is a particular form of atherothrombotic disease characterized by the dilation of the aortic wall and the presence of an intraluminal thrombus (ILT). The objective of the present study was to evaluate the pro-oxidant properties of the ILT and to characterize the anti-oxidant capacity of high-density lipoproteins (HDLs). METHODS AND RESULTS: Our results show that ILT, adventitia, and plasma from AAA patients contained high concentrations of lipid and protein oxidation products. Mediators produced within or released by the thrombus and the adventitia were shown to induce reactive oxygen species (ROS) production by cultured aortic smooth muscle cells (AoSMCs) and to trigger the onset of apoptosis (an increase in mitochondrial membrane potential). Iron chelation limited these effects. Both concentration and functionality of HDLs were altered in AAA patients. Plasma levels of Apo A-I were lower, and small HDL subclasses were decreased in AAA patients. Circulating HDLs in AAA patients displayed an impaired capacity to inhibit copper-induced low-density lipoprotein oxidation and AoSMC ROS production. Western blot analyses of HDLs demonstrated that myeloperoxidase is associated with HDL particles in AAA patients. CONCLUSION: ILT and adventitia are a source of pro-oxidant products, in particular haemoglobin, which may impact on the wall stability/rupture in AAA. In addition, HDLs from AAA patients exhibit an impaired anti-oxidant activity. In this context, restoring HDL functionality may represent a new therapeutic option in AAA.", "author" : [ { "dropping-particle" : "", "family" : "Delbosc", "given" : "S", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Diallo", "given" : "D", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Dejouvencel", "given" : "T", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Lamiral", "given" : "Z", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Louedec", "given" : "L", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Martin-Ventura", "given" : "J L", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Rossignol", "given" : "P", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Leseche", "given" : "G", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Michel", "given" : "J B", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Meilhac", "given" : "O", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Cardiovasc Res", "id" : "ITEM-1", "issue" : "2", "issued" : { "date-parts" : [ [ "2013" ] ] }, "note" : "Delbosc, Sandrine\nDiallo, Devy\nDejouvencel, Tiphaine\nLamiral, Zohra\nLouedec, Liliane\nMartin-Ventura, Jose-Luis\nRossignol, Patrick\nLeseche, Guy\nMichel, Jean-Baptiste\nMeilhac, Olivier\neng\nResearch Support, Non-U.S. Gov't\nEngland\n2013/08/21 06:00\nCardiovasc Res. 2013 Nov 1;100(2):307-15. doi: 10.1093/cvr/cvt194. Epub 2013 Aug 16.", "page" : "307-315", "title" : "Impaired high-density lipoprotein anti-oxidant capacity in human abdominal aortic aneurysm", "type" : "article-journal", "volume" : "100" }, "uris" : [ "http://www.mendeley.com/documents/?uuid=8ecdc1f8-f271-4632-a801-5690846335d4" ] } ], "mendeley" : { "formattedCitation" : "103", "plainTextFormattedCitation" : "103", "previouslyFormattedCitation" : "103" }, "properties" : { }, "schema" : "https://github.com/citation-style-language/schema/raw/master/csl-citation.json" }103 and AAA growth has been associated with a decrease in circulating Apo-A1 and HDL.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1160/TH14-10-0874", "ISBN" : "2567-689X (Electronic)\r0340-6245 (Linking)", "PMID" : "25789510", "abstract" : "Abdominal aortic aneurysm (AAA) evolution is unpredictable, and there is no therapy except surgery for patients with an aortic size> 5 cm (large AAA). We aimed to identify new potential biomarkers that could facilitate prognosis and treatment of patients with AAA. A differential quantitative proteomic analysis of plasma proteins was performed in AAA patients at different stages of evolution [small AAA (aortic size=3-5 cm) vs large AAA] using iTRAQ labelling, high-throughput nano-LC-MS/MS and a novel multi-layered statistical model. Among the proteins identified, ApoA-I was decreased in patients with large AAA compared to those with small AAA. These results were validated by ELISA on plasma samples from small (n=90) and large AAA (n=26) patients (150+/- 3 vs 133+/- 5 mg/dl, respectively, p< 0.001). ApoA-I levels strongly correlated with HDL-Cholesterol (HDL-C) concentration (r=0.9, p< 0.001) and showed a negative correlation with aortic size (r=-0.4, p< 0.01) and thrombus volume (r=-0.3, p< 0.01), which remained significant after adjusting for traditional risk factors. In a prospective study, HDL-C independently predicted aneurysmal growth rate in multiple linear regression analysis (n=122, p=0.008) and was inversely associated with need for surgical repair (Adjusted hazard ratio: 0.18, 95 % confidence interval: 0.04-0.74, p=0.018). In a nation-wide Danish registry, we found lower mean HDL-C concentration in large AAA patients (n=6,560) compared with patients with aorto-iliac occlusive disease (n=23,496) (0.89+/- 2.99 vs 1.59+/- 5.74 mmol/l, p< 0.001). Finally, reduced mean aortic AAA diameter was observed in AngII-infused mice treated with ApoA-I mimetic peptide compared with saline-injected controls. In conclusion, ApoA-I/HDL-C systemic levels are negatively associated with AAA evolution. Therapies targeting HDL functionality could halt AAA formation.", "author" : [ { "dropping-particle" : "", "family" : "Burillo", "given" : "E", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Lindholt", "given" : "J S", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Molina-Sanchez", "given" : "P", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Jorge", "given" : "I", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Martinez-Pinna", "given" : "R", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Blanco-Colio", "given" : "L M", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Tarin", "given" : "C", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Torres-Fonseca", "given" : "M M", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Esteban", "given" : "M", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Laustsen", "given" : "J", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Ramos-Mozo", "given" : "P", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Calvo", "given" : "E", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Lopez", "given" : "J A", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Vega de Ceniga", "given" : "M", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Michel", "given" : "J B", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Egido", "given" : "J", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Andres", "given" : "V", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Vazquez", "given" : "J", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Meilhac", "given" : "O", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Martin-Ventura", "given" : "J L", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Thromb Haemost", "id" : "ITEM-1", "issue" : "6", "issued" : { "date-parts" : [ [ "2015" ] ] }, "note" : "Burillo, Elena\nLindholt, Jes S\nMolina-Sanchez, Pedro\nJorge, Immaculada\nMartinez-Pinna, Roxana\nBlanco-Colio, Luis Miguel\nTarin, Carlos\nTorres-Fonseca, Monica Maria\nEsteban, Margarita\nLaustsen, Jesper\nRamos-Mozo, Priscilla\nCalvo, Enrique\nLopez, Juan Antonio\nVega de Ceniga, Melina\nMichel, Jean-Baptiste\nEgido, Jesus\nAndres, Vicente\nVazquez, Jesus\nMeilhac, Olivier\nMartin-Ventura, Jose Luis\neng\nComparative Study\nObservational Study\nResearch Support, Non-U.S. Gov't\nGermany\n2015/03/20 06:00\nThromb Haemost. 2015 Jun;113(6):1335-46. doi: 10.1160/TH14-10-0874. Epub 2015 Mar 19.", "page" : "1335-1346", "title" : "ApoA-I/HDL-C levels are inversely associated with abdominal aortic aneurysm progression", "type" : "article-journal", "volume" : "113" }, "uris" : [ "http://www.mendeley.com/documents/?uuid=22f14139-da2d-4453-b3e7-b613288cb92c" ] } ], "mendeley" : { "formattedCitation" : "92", "plainTextFormattedCitation" : "92", "previouslyFormattedCitation" : "92" }, "properties" : { }, "schema" : "https://github.com/citation-style-language/schema/raw/master/csl-citation.json" }92 The decrease in HDLs is directly linked to their convection through the highly oxidative wall, the oxidation of apo-A1 and the dissociation of apo-A1 and the release of its lipid cargo. ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1161/CIRCULATIONAHA.113.002624", "ISBN" : "1524-4539 (Electronic)\r0009-7322 (Linking)", "PMID" : "23969698", "abstract" : "BACKGROUND: Prior studies show that apolipoprotein A1 (apoA1) recovered from human atherosclerotic lesions is highly oxidized. Ex vivo oxidation of apoA1 or high-density lipoprotein (HDL) cross-links apoA1 and impairs lipid binding, cholesterol efflux, and lecithin-cholesterol acyltransferase activities of the lipoprotein. Remarkably, no studies to date directly quantify either the function or HDL particle distribution of apoA1 recovered from the human artery wall. METHODS AND RESULTS: A monoclonal antibody (10G1.5) was developed that equally recognizes lipid-free and HDL-associated apoA1 in both native and oxidized forms. Examination of homogenates of atherosclerotic plaque-laden aorta showed >100-fold enrichment of apoA1 compared with normal aorta (P<0.001). Surprisingly, buoyant density fractionation revealed that only a minority (<3% of total) of apoA1 recovered from either lesions or normal aorta resides within an HDL-like particle (1.06390%) of apoA1 within aortic tissue (normal and lesions) was recovered within the lipoprotein-depleted fraction (d>1.21). Moreover, both lesion and normal artery wall apoA1 are highly cross-linked (50% to 70% of total), and functional characterization of apoA1 quantitatively recovered from aorta with the use of monoclonal antibody 10G1.5 showed approximately 80% lower cholesterol efflux activity and approximately 90% lower lecithin-cholesterol acyltransferase activity relative to circulating apoA1. CONCLUSIONS: The function and distribution of apoA1 in human aorta are quite distinct from those found in plasma. The lipoprotein is markedly enriched within atherosclerotic plaque, predominantly lipid-poor, not associated with HDL, extensively oxidatively cross-linked, and functionally impaired.", "author" : [ { "dropping-particle" : "", "family" : "DiDonato", "given" : "J A", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Huang", "given" : "Y", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Aulak", "given" : "K S", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Even-Or", "given" : "O", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Gerstenecker", "given" : "G", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Gogonea", "given" : "V", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Wu", "given" : "Y", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Fox", "given" : "P L", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Tang", "given" : "W H", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Plow", "given" : "E F", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Smith", "given" : "J D", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Fisher", "given" : "E A", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Hazen", "given" : "S L", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Circulation", "id" : "ITEM-1", "issue" : "15", "issued" : { "date-parts" : [ [ "2013" ] ] }, "note" : "DiDonato, Joseph A\nHuang, Ying\nAulak, Kulwant S\nEven-Or, Orli\nGerstenecker, Gary\nGogonea, Valentin\nWu, Yuping\nFox, Paul L\nTang, W H Wilson\nPlow, Edward F\nSmith, Jonathan D\nFisher, Edward A\nHazen, Stanley L\neng\nHL17964/HL/NHLBI NIH HHS/\nR01 HL103931/HL/NHLBI NIH HHS/\nP01 HL076491/HL/NHLBI NIH HHS/\nP01HL098055/HL/NHLBI NIH HHS/\nP01 HL098055/HL/NHLBI NIH HHS/\nP01HL076491/HL/NHLBI NIH HHS/\nUL1 TR000439/TR/NCATS NIH HHS/\nR01 HL017964/HL/NHLBI NIH HHS/\nResearch Support, N.I.H., Extramural\nResearch Support, Non-U.S. Gov't\n2013/08/24 06:00\nCirculation. 2013 Oct 8;128(15):1644-55. doi: 10.1161/CIRCULATIONAHA.113.002624. Epub 2013 Aug 22.", "page" : "1644-1655", "title" : "Function and distribution of apolipoprotein A1 in the artery wall are markedly distinct from those in plasma", "type" : "article-journal", "volume" : "128" }, "uris" : [ "http://www.mendeley.com/documents/?uuid=e973587a-cbd0-48b5-a32b-bbbc65defe5b" ] } ], "mendeley" : { "formattedCitation" : "104", "plainTextFormattedCitation" : "104", "previouslyFormattedCitation" : "104" }, "properties" : { }, "schema" : "https://github.com/citation-style-language/schema/raw/master/csl-citation.json" }104 Myeloperoxidase can be detected in patients plasma as an oxidative stress marker produced by neutrophils. Free radical production has also been correlated to clinical features, and the overall mortality risk.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1179/1351000212Y.0000000012 rer-11-44 [pii]", "ISBN" : "1743-2928 (Electronic) 1351-0002 (Linking)", "PMID" : "22732574", "abstract" : "BACKGROUND: Abdominal aortic aneurysm (AAA) is a major cause of preventable deaths in older patients. Oxidative stress has been suggested to play a key role in the pathogenesis of AAA. However, only few studies have been conducted to evaluate the blood oxidative stress status of AAA patients. METHODS AND RESULTS: Twenty seven AAA patients (mean age of 70 years) divided into two groups according to AAA size ( 50 mm) were compared with an age-matched group of 18 healthy subjects. Antioxidants (vitamins C and E, beta-carotene, glutathione, thiols, and ubiquinone), trace elements (selenium, copper, zinc, and copper/zinc ratio) and markers of oxidative damage to lipids (lipid peroxides, antibodies against oxidized patients, and isoprostanes) were measured in each subject. The comparison of the three groups by ordinal logistic regression showed a significant decrease of the plasma levels of vitamin C (P = 0.011), alpha-tocopherol (P = 0.016) but not when corrected for cholesterol values, beta-carotene (P = 0.0096), ubiquinone (P = 0.014), zinc (P = 0.0035), and of selenium (P = 0.0038), as AAA size increased. By contrast, specific markers of lipid peroxidation such as the Cu/Zn ratio (P = 0.046) and to a lesser extent isoprostanes (P = 0.052) increased. CONCLUSION: The present study emphasizes the potential role of the oxidative stress in AAA disease and suggests that an antioxidant therapy could be of interest to delay AAA progression.", "author" : [ { "dropping-particle" : "", "family" : "Pincemail", "given" : "J", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Defraigne", "given" : "J O", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Cheramy-Bien", "given" : "J P", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Dardenne", "given" : "N", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Donneau", "given" : "A F", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Albert", "given" : "A", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Labropoulos", "given" : "N", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Sakalihasan", "given" : "N", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Redox Rep", "edition" : "2012/06/27", "id" : "ITEM-1", "issue" : "4", "issued" : { "date-parts" : [ [ "2012" ] ] }, "language" : "eng", "note" : "Pincemail, J\nDefraigne, J O\nCheramy-Bien, J P\nDardenne, N\nDonneau, A F\nAlbert, A\nLabropoulos, N\nSakalihasan, N\nResearch Support, Non-U.S. Gov't\nEngland\nRedox report : communications in free radical research\nRedox Rep. 2012;17(4):139-44. doi: 10.1179/1351000212Y.0000000012. Epub 2012 Jun 21.", "page" : "139-144", "title" : "On the potential increase of the oxidative stress status in patients with abdominal aortic aneurysm", "type" : "article-journal", "volume" : "17" }, "uris" : [ "http://www.mendeley.com/documents/?uuid=31c2b7cf-2619-4633-90a0-bc2ea62381fb" ] } ], "mendeley" : { "formattedCitation" : "105", "plainTextFormattedCitation" : "105", "previouslyFormattedCitation" : "105" }, "properties" : { }, "schema" : "https://github.com/citation-style-language/schema/raw/master/csl-citation.json" }105 By modifying protein antigenicity, oxidative stress is the main determinant of immune adaptive response in AAA.
[H1] Diagnosis, screening and prevention
[H2] Clinical diagnosis of AAA
In countries with no population-based screening programmes, most patients with intact, asymptomatic AAA referred to vascular departments are diagnosed incidentally when a radiological examination was performed for another medical condition. This situation changes, where population-based screening in men has been introduced, leading to a decline in the incidence of ruptured AAA in men.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1002/bjs.5780", "ISBN" : "0007-1323 (Print) 0007-1323 (Linking)", "PMID" : "17514666", "abstract" : "BACKGROUND: Long-term benefits of screening for abdominal aortic aneurysm (AAA) are uncertain. These are the final results of a randomized controlled screening trial for AAA in men, updating those reported previously. Benefit and compliance over a median 15-year interval were examined. METHODS: One group of men were invited for ultrasonographic AAA screening, and another group, who received standard care, acted as controls. A total of 6040 men aged 65-80 years were randomized to one of the two groups. Outcome was monitored in terms of AAA-related events (surgery or death). RESULTS: In the group invited for screening, AAA-related mortality was reduced by 11 per cent (from 1.8 to 1.6 per cent, hazard ratio 0.89) over the follow-up interval. Screening detected an AAA in 170 patients; 17 of these died from an AAA-related cause, seven of which might have been preventable. The incidence of AAA rupture after an initially normal scan increased after 10 years of follow-up, but was still low overall (0.56 per 1000 person-years). CONCLUSION: Screening with a single ultrasonography scan still conferred a benefit at 15 years, although the results were not significant for this population size. Fewer than half of the AAA-related deaths in those screened positive could be prevented. Registration number: ISRCTN 00079388 (http://www.controlled-trials.com).", "author" : [ { "dropping-particle" : "", "family" : "Ashton", "given" : "H A", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Gao", "given" : "L", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Kim", "given" : "L G", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Druce", "given" : "P S", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Thompson", "given" : "S G", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Scott", "given" : "R A", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Br J Surg", "edition" : "2007/05/22", "id" : "ITEM-1", "issue" : "6", "issued" : { "date-parts" : [ [ "2007" ] ] }, "language" : "eng", "note" : "Ashton, H A\nGao, L\nKim, L G\nDruce, P S\nThompson, S G\nScott, R A P\nMulticenter Study\nRandomized Controlled Trial\nResearch Support, Non-U.S. Gov't\nEngland\nThe British journal of surgery\nBr J Surg. 2007 Jun;94(6):696-701.", "page" : "696-701", "title" : "Fifteen-year follow-up of a randomized clinical trial of ultrasonographic screening for abdominal aortic aneurysms", "type" : "article-journal", "volume" : "94" }, "uris" : [ "http://www.mendeley.com/documents/?uuid=76e1b447-ec54-4089-83ba-952125fba15c" ] }, { "id" : "ITEM-2", "itemData" : { "DOI" : "10.1002/bjs.10715", "ISBN" : "1365-2168 (Electronic)\r0007-1323 (Linking)", "PMID" : "29265406", "abstract" : "BACKGROUND: This study aimed to assess how the prevalence and growth rates of small and medium abdominal aortic aneurysms (AAAs) (3.0-5.4 cm) have changed over time in men aged 65 years, and to evaluate long-term outcomes in men whose aortic diameter is 2.6-2.9 cm (subaneurysmal), and below the standard threshold for most surveillance programmes. METHODS: The Gloucestershire Aneurysm Screening Programme (GASP) started in 1990. Men aged 65 years with an aortic diameter of 2.6-5.4 cm, measured by ultrasonography using the inner to inner wall method, were included in surveillance. Aortic diameter growth rates were estimated separately for men who initially had a subaneurysmal aorta, and those who had a small or medium AAA, using mixed-effects models. RESULTS: Since 1990, 81 150 men had ultrasound screening for AAA (uptake 80.7 per cent), of whom 2795 had an aortic diameter of 2.6-5.4 cm. The prevalence of screen-detected AAA of 3.0 cm or larger decreased from 5.0 per cent in 1991 to 1.3 per cent in 2015. There was no evidence of a change in AAA growth rates during this time. Of men who initially had a subaneurysmal aorta, 57.6 (95 per cent c.i. 54.4 to 60.7) per cent were estimated to develop an AAA of 3.0 cm or larger within 5 years of the initial scan, and 28.0 (24.2 to 31.8) per cent to develop a large AAA (at least 5.5 cm) within 15 years. CONCLUSION: The prevalence of screen-detected small and medium AAAs has decreased over the past 25 years, but growth rates have remained similar. Men with a subaneurysmal aorta at age 65 years have a substantial risk of developing a large AAA by the age of 80 years.", "author" : [ { "dropping-particle" : "", "family" : "Oliver-Williams", "given" : "C", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Sweeting", "given" : "M J", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Turton", "given" : "G", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Parkin", "given" : "D", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Cooper", "given" : "D", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Rodd", "given" : "C", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Thompson", "given" : "S G", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Earnshaw", "given" : "J J", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Gloucestershire", "given" : "", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Swindon Abdominal Aortic Aneurysm Screening", "given" : "Programme", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Br J Surg", "id" : "ITEM-2", "issue" : "1", "issued" : { "date-parts" : [ [ "2018" ] ] }, "note" : "Oliver-Williams, C\nSweeting, M J\nTurton, G\nParkin, D\nCooper, D\nRodd, C\nThompson, S G\nEarnshaw, J J\neng\nEngland\n2017/12/22 06:00\nBr J Surg. 2018 Jan;105(1):68-74. doi: 10.1002/bjs.10715.", "page" : "68-74", "title" : "Lessons learned about prevalence and growth rates of abdominal aortic aneurysms from a 25-year ultrasound population screening programme", "type" : "article-journal", "volume" : "105" }, "uris" : [ "http://www.mendeley.com/documents/?uuid=67612048-6c73-43f5-896a-6a7221a7aaba" ] }, { "id" : "ITEM-3", "itemData" : { "DOI" : "10.1002/bjs.5778", "ISBN" : "0007-1323 (Print)\r0007-1323 (Linking)", "PMID" : "17514693", "abstract" : "BACKGROUND: The aim was to determine whether early open surgical repair would benefit patients with small abdominal aortic aneurysm compared with surveillance on long-term follow-up. METHODS: The 1090 patients who were enrolled into the UK Small Aneurysm Trial between 1991 and 1995 were followed up for aneurysm repair and mortality until November 2005. RESULTS: By November 2005, 714 patients (65.5 per cent) had died, 929 (85.2 per cent) had undergone aneurysm repair, 150 (13.8 per cent) had died without aneurysm repair and 11 (1.0 per cent) remained alive without aneurysm repair. After 12 years, mortality in the surgery and surveillance groups was 63.9 and 67.3 per cent respectively, unadjusted hazard ratio 0.90 (P = 0.139). Three-quarters of the surveillance group eventually had aneurysm repair, with a 30-day elective mortality of 6.3 per cent (versus 5.0 per cent in the early surgery group, P = 0.366). Estimates suggested that the cost of treatment was 17 per cent higher in the early surgery group, with a mean difference of 1326 pounds. The death rate in these patients was about twice that in the population matched for age and sex. CONCLUSION: There was no long-term survival benefit of early elective open repair of small abdominal aortic aneurysms. Even after successful aneurysm repair, the mortality among these patients was higher than in the general population.", "author" : [ { "dropping-particle" : "", "family" : "Powell", "given" : "J T", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Brown", "given" : "L C", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Forbes", "given" : "J F", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Fowkes", "given" : "F G", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Greenhalgh", "given" : "R M", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "V", "family" : "Ruckley", "given" : "C", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Thompson", "given" : "S G", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Br J Surg", "id" : "ITEM-3", "issue" : "6", "issued" : { "date-parts" : [ [ "2007" ] ] }, "note" : "Powell, J T\nBrown, L C\nForbes, J F\nFowkes, F G R\nGreenhalgh, R M\nRuckley, C V\nThompson, S G\neng\nMC_U105260792/Medical Research Council/United Kingdom\nMulticenter Study\nRandomized Controlled Trial\nResearch Support, Non-U.S. Gov't\nEngland\n2007/05/22 09:00\nBr J Surg. 2007 Jun;94(6):702-8. doi: 10.1002/bjs.5778.", "page" : "702-708", "title" : "Final 12-year follow-up of surgery versus surveillance in the UK Small Aneurysm Trial", "type" : "article-journal", "volume" : "94" }, "uris" : [ "http://www.mendeley.com/documents/?uuid=adcd2d7e-8a9b-4031-bfed-597487a0d717" ] }, { "id" : "ITEM-4", "itemData" : { "DOI" : "10.1161/CIRCULATIONAHA.116.022305", "ISBN" : "1524-4539 (Electronic)\r0009-7322 (Linking)", "PMID" : "27630132", "abstract" : "BACKGROUND: A general abdominal aortic aneurysm (AAA) screening program, targeting 65-year-old men, has gradually been introduced in Sweden since 2006 and reached nationwide coverage in 2015. The aim of this study was to determine the outcome of this program. METHODS: Data on the number of invited and examined men, screening-detected AAAs, AAAs operated on, and surgical outcome were retrieved from all 21 Swedish counties for the years 2006 through 2014. AAA-specific mortality data were retrieved from the Swedish Cause of Death Registry. A linear regression analysis was used to estimate the effect on AAA-specific mortality among all men >/=65 years of age for the observed time period. The long-term effects were projected by using a validated Markov model. RESULTS: Of 302 957 men aged 65 years invited, 84% attended. The prevalence of screening-detected AAA was 1.5%. After a mean of 4.5 years, 29% of patients with AAA had been operated on, with a 30-day mortality rate of 0.9% (1.3% after open repair and 0.3% after endovascular repair, P<0.001). The introduction of screening was associated with a significant reduction in AAA-specific mortality (mean, 4.0% per year of screening, P=0.020). The number needed to screen and the number needed to operate on to prevent 1 premature death were 667 and 1.5, respectively. With a total population of 9.5 million, the Swedish national AAA-screening program was predicted to annually prevent 90 premature deaths from AAA and to gain 577 quality-adjusted life-years. The incremental cost-efficiency ratio was estimated to be euro7770 per quality-adjusted life-years. CONCLUSIONS: Screening 65-year-old men for AAA is an effective preventive health measure and is highly cost-effective in a contemporary setting. These findings confirm the results from earlier randomized controlled trials and model studies in a large population-based setting of the importance for future healthcare decision making.", "author" : [ { "dropping-particle" : "", "family" : "Wanhainen", "given" : "A", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Hultgren", "given" : "R", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Linne", "given" : "A", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Holst", "given" : "J", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Gottsater", "given" : "A", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Langenskiold", "given" : "M", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Smidfelt", "given" : "K", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Bjorck", "given" : "M", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Svensjo", "given" : "S", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Swedish Aneurysm Screening Study", "given" : "Group", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Circulation", "id" : "ITEM-4", "issue" : "16", "issued" : { "date-parts" : [ [ "2016" ] ] }, "note" : "Wanhainen, Anders\nHultgren, Rebecka\nLinne, Anneli\nHolst, Jan\nGottsater, Anders\nLangenskiold, Marcus\nSmidfelt, Kristian\nBjorck, Martin\nSvensjo, Sverker\n(SASS)\neng\n2016/10/19 06:00\nCirculation. 2016 Oct 18;134(16):1141-1148. doi: 10.1161/CIRCULATIONAHA.116.022305. Epub 2016 Sep 14.", "page" : "1141-1148", "title" : "Outcome of the Swedish Nationwide Abdominal Aortic Aneurysm Screening Program", "type" : "article-journal", "volume" : "134" }, "uris" : [ "http://www.mendeley.com/documents/?uuid=0a65ec7f-1fdf-4c3b-9b9b-f15d93ec5108" ] } ], "mendeley" : { "formattedCitation" : "8,42,43,115", "plainTextFormattedCitation" : "8,42,43,115", "previouslyFormattedCitation" : "8,42,43,115" }, "properties" : { }, "schema" : "https://github.com/citation-style-language/schema/raw/master/csl-citation.json" }8,42,43,115 A very small fraction of patients with intact asymptomatic AAA are diagnosed with a pulsatile mass at a clinical examination or because the large AAA compresses other intraabdominal organs.
Patients with ruptured AAA who survive the first episode of bleeding are usually admitted as an emergency with abdominal pain. The classic triad of clinical signs (abdominal or back pain, hypotension or shock, and abdominal pulsatile mass)ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "ISBN" : "0267-0623 (Print)\r0267-0623 (Linking)", "PMID" : "6788329", "abstract" : "Between 1960 and 1979 528 patients with abdominal aortic aneurysms presented to the university department of surgery. Of these, 222 (42%) were elective cases, 72 acute (14%), 174 had ruptured (33%), and four had had a spontaneous aortoduodenal fistula (1%). In all these patients resections were undertaken, but in another 56 patients (11%) the aneurysm was not resected. A review of these cases showed that 91% had symptoms at their first presentation; abdominal pain and backache being most common. The diagnosis could be established in 91% by the presence of pulsatile abdominal mass on clinical examination. The operative mortality for elective resection was 8%, for acute 19%, for ruptured cases 42%, and for spontaneous aortoduodenal fistula 50%. After successful resection the overall five-year survival was 65% by the life table method, and there was no significant difference between elective, acute, and ruptured cases. This five-year survival after resection compares favourably with the expected 76% survival of a similar normal population, and was considerably better than that for conservatively treated patients. As most cases have symptoms, and diagnosis may be established easily by routine physical examination in 91%, the prognosis for this condition could be considerably improved by increased awareness of its existence and early referral for treatment as an elective surgical procedure.", "author" : [ { "dropping-particle" : "", "family" : "Fielding", "given" : "J W", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Black", "given" : "J", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Ashton", "given" : "F", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Slaney", "given" : "G", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Campbell", "given" : "D J", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Br Med J (Clin Res Ed)", "id" : "ITEM-1", "issue" : "6287", "issued" : { "date-parts" : [ [ "1981" ] ] }, "note" : "Fielding, J W\nBlack, J\nAshton, F\nSlaney, G\nCampbell, D J\neng\nEngland\nClinical research ed.\n1981/08/01 00:00\nBr Med J (Clin Res Ed). 1981 Aug 1;283(6287):355-9.", "page" : "355-359", "title" : "Diagnosis and management of 528 abdominal aortic aneurysms", "type" : "article-journal", "volume" : "283" }, "uris" : [ "http://www.mendeley.com/documents/?uuid=b4f98dc2-54e3-4ff2-bffb-5fe31d5bd09a" ] }, { "id" : "ITEM-2", "itemData" : { "ISBN" : "0741-5214 (Print)\r0741-5214 (Linking)", "PMID" : "1619721", "abstract" : "Ruptured abdominal aortic aneurysm is a surgical emergency with a high mortality rate even when diagnosed and repaired immediately. We retrospectively reviewed 152 cases of ruptured abdominal aneurysms to identify the incidence of misdiagnosis leading to a delay in treatment, the most frequent misdiagnoses, and the outcome in this group of patients. Forty-six (30%) were initially misdiagnosed. The most common misdiagnoses were renal colic, diverticulitis, and gastrointestinal hemorrhage. The most common initial physical findings in misdiagnosed patients were abdominal pain (70%), shock (57%), and back pain (50%). A pulsatile abdominal mass was found in only 26% of misdiagnosed patients versus 72% of patients correctly diagnosed (p less than 0.005). Misdiagnosed ruptured abdominal aneurysm had a 44% mortality rate, which was not significantly different from patients correctly diagnosed (58%, p = 0.34). The lack of difference in mortality rates is most likely due to preselection of those misdiagnosed patients who were able to withstand the delay in diagnosis and survive to surgical treatment. The 30% incidence of misdiagnosis in this series suggests that it is frequently a difficult diagnosis to make and must be considered in elderly patients, especially men, who are admitted with abdominal pain and/or back pain.", "author" : [ { "dropping-particle" : "", "family" : "Marston", "given" : "W A", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Ahlquist", "given" : "R", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Johnson Jr.", "given" : "G", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Meyer", "given" : "A A", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "J Vasc Surg", "id" : "ITEM-2", "issue" : "1", "issued" : { "date-parts" : [ [ "1992" ] ] }, "note" : "Marston, W A\nAhlquist, R\nJohnson, G Jr\nMeyer, A A\neng\n1992/07/01 00:00\nJ Vasc Surg. 1992 Jul;16(1):17-22.", "page" : "17-22", "title" : "Misdiagnosis of ruptured abdominal aortic aneurysms", "type" : "article-journal", "volume" : "16" }, "uris" : [ "http://www.mendeley.com/documents/?uuid=868d341d-52d9-4ec9-898b-4e648a9abd20" ] } ], "mendeley" : { "formattedCitation" : "116,117", "plainTextFormattedCitation" : "116,117", "previouslyFormattedCitation" : "116,117" }, "properties" : { }, "schema" : "https://github.com/citation-style-language/schema/raw/master/csl-citation.json" }116,117 d o e s n o t a l w a y s l e a d t o a n a c c u r a t e d i a g n o s i s o f A A A , s i n c e o n l y 2 5 "5 0 % o f p a t i e n t s w i t h r u p t u r e d A A A d e m o n s t r a t e a l l t r i a d s i g n s . A D D I N C S L _ C I T A T I O N { " c i t a t i o n I t e m s " : [ { " i d " : " I T E M - 1 " , " i t e m D a t a " : { " I S B N " : " 0 2 6 7 - 0 6 2 3 ( P r i n t ) \ r 0 2 6 7 - 0 6 2 3 ( L i n k i n g ) " , "PMID" : "6788329", "abstract" : "Between 1960 and 1979 528 patients with abdominal aortic aneurysms presented to the university department of surgery. Of these, 222 (42%) were elective cases, 72 acute (14%), 174 had ruptured (33%), and four had had a spontaneous aortoduodenal fistula (1%). In all these patients resections were undertaken, but in another 56 patients (11%) the aneurysm was not resected. A review of these cases showed that 91% had symptoms at their first presentation; abdominal pain and backache being most common. The diagnosis could be established in 91% by the presence of pulsatile abdominal mass on clinical examination. The operative mortality for elective resection was 8%, for acute 19%, for ruptured cases 42%, and for spontaneous aortoduodenal fistula 50%. After successful resection the overall five-year survival was 65% by the life table method, and there was no significant difference between elective, acute, and ruptured cases. This five-year survival after resection compares favourably with the expected 76% survival of a similar normal population, and was considerably better than that for conservatively treated patients. As most cases have symptoms, and diagnosis may be established easily by routine physical examination in 91%, the prognosis for this condition could be considerably improved by increased awareness of its existence and early referral for treatment as an elective surgical procedure.", "author" : [ { "dropping-particle" : "", "family" : "Fielding", "given" : "J W", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Black", "given" : "J", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Ashton", "given" : "F", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Slaney", "given" : "G", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Campbell", "given" : "D J", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Br Med J (Clin Res Ed)", "id" : "ITEM-1", "issue" : "6287", "issued" : { "date-parts" : [ [ "1981" ] ] }, "note" : "Fielding, J W\nBlack, J\nAshton, F\nSlaney, G\nCampbell, D J\neng\nEngland\nClinical research ed.\n1981/08/01 00:00\nBr Med J (Clin Res Ed). 1981 Aug 1;283(6287):355-9.", "page" : "355-359", "title" : "Diagnosis and management of 528 abdominal aortic aneurysms", "type" : "article-journal", "volume" : "283" }, "uris" : [ "http://www.mendeley.com/documents/?uuid=b4f98dc2-54e3-4ff2-bffb-5fe31d5bd09a" ] }, { "id" : "ITEM-2", "itemData" : { "ISBN" : "0741-5214 (Print)\r0741-5214 (Linking)", "PMID" : "1619721", "abstract" : "Ruptured abdominal aortic aneurysm is a surgical emergency with a high mortality rate even when diagnosed and repaired immediately. We retrospectively reviewed 152 cases of ruptured abdominal aneurysms to identify the incidence of misdiagnosis leading to a delay in treatment, the most frequent misdiagnoses, and the outcome in this group of patients. Forty-six (30%) were initially misdiagnosed. The most common misdiagnoses were renal colic, diverticulitis, and gastrointestinal hemorrhage. The most common initial physical findings in misdiagnosed patients were abdominal pain (70%), shock (57%), and back pain (50%). A pulsatile abdominal mass was found in only 26% of misdiagnosed patients versus 72% of patients correctly diagnosed (p less than 0.005). Misdiagnosed ruptured abdominal aneurysm had a 44% mortality rate, which was not significantly different from patients correctly diagnosed (58%, p = 0.34). The lack of difference in mortality rates is most likely due to preselection of those misdiagnosed patients who were able to withstand the delay in diagnosis and survive to surgical treatment. The 30% incidence of misdiagnosis in this series suggests that it is frequently a difficult diagnosis to make and must be considered in elderly patients, especially men, who are admitted with abdominal pain and/or back pain.", "author" : [ { "dropping-particle" : "", "family" : "Marston", "given" : "W A", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Ahlquist", "given" : "R", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Johnson Jr.", "given" : "G", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Meyer", "given" : "A A", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "J Vasc Surg", "id" : "ITEM-2", "issue" : "1", "issued" : { "date-parts" : [ [ "1992" ] ] }, "note" : "Marston, W A\nAhlquist, R\nJohnson, G Jr\nMeyer, A A\neng\n1992/07/01 00:00\nJ Vasc Surg. 1992 Jul;16(1):17-22.", "page" : "17-22", "title" : "Misdiagnosis of ruptured abdominal aortic aneurysms", "type" : "article-journal", "volume" : "16" }, "uris" : [ "http://www.mendeley.com/documents/?uuid=868d341d-52d9-4ec9-898b-4e648a9abd20" ] } ], "mendeley" : { "formattedCitation" : "116,117", "plainTextFormattedCitation" : "116,117", "previouslyFormattedCitation" : "116,117" }, "properties" : { }, "schema" : "https://github.com/citation-style-language/schema/raw/master/csl-citation.json" }116,117 Today most patients admitted to the emergency room with severe abdominal pain are subjected to ultrasonography (Fig 5 confirming the existence of an AAA followed by a computed tomography (CT) angiogram. The introduction and increasingly widespread use of endovascular aneurysm repair (EVAR) in the treatment of ruptured AAA has necessitated the use of CT angiograms. CT increases the specificity of the diagnosis of rupture, evaluates morphological suitability for EVAR and also improves the quality of open repair.
[H2] Conventional imaging
Many patients are diagnosed primarily with ultrasonography of the abdomen, which is a cheap, highly specific, noninvasive and harmless examination, generally c o n s i d e r e d a s t h e g o l d s t a n d a r d i n a s y m p t o m a t i c p a t i e n t s . P a t i e n t s w i t h a l a r g e r ( > 5 5 m m ) , s y m p t o m a t i c o r r u p t u r e d A A A a r e u s u a l l y s u b j e c t e d t o C T i m a g i n g . C T a n g i o g r a m s s h o u l d p r e f e r a b l y b e p e r f o r m e d w i t h a m a x i m u m o f 0 . 5 "1 m m s l i c e - t h i c k n e s s , a n d w i t h c ontrast in the arterial phase. The CT scan will support the diagnosis, detect possible concurrent aneurysmal disease in other vessels, and give the possibility to plan the surgical intervention (open or EVAR). Magnetic resonance imaging (MRI) cannot be performed in emergency situations, but is important as an adjunct imaging method, specifically in patients with contraindications to iodinated CT contrast agents, such as mild to moderate renal insufficiency and allergy.
[H2] Functional imaging
Functional imaging refers to the assessment of pathophysiological pathways involved in AAA. It includes metabolic and molecular imaging, of which Positron Emission Tomography (PET) is the flagship in clinical practice. PET produces three-dimensional (3D) images from an internal source after injection of a radionuclide, also known as a tracer that often specifically tracks physiological processes or tissues. Fluorodeoxy-glucose-F18 (18 F "F D G ) i s o n e o f t h e m o s t w i d e l y u s e d t r a c e r s . I t e n t e r s c e l l s a s a g l u c o s e a n a l o g u e a n d i s p h o s p h o r y l a t e d t o 1 8 F "F D G - 6 - p h o s p h a t e . A s 1 8 F - F D G - 6 - p h o s p h a t e c a n n e i t h e r e n t e r t h e g l y c o l y t i c c y c l e n o r e x i t t h e c e l l , i t s a c c u m u l a t i o n i d e n t i f i e s s i t e s o f i n c r e a s ed glycolysis, such as inflammatory foci and cancer.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.2967/jnumed.109.072355", "ISBN" : "1535-5667 (Electronic)\r0161-5505 (Linking)", "PMID" : "20395327", "author" : [ { "dropping-particle" : "", "family" : "Rudd", "given" : "J H", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "J Nucl Med", "id" : "ITEM-1", "issue" : "5", "issued" : { "date-parts" : [ [ "2010" ] ] }, "note" : "Rudd, James H F\neng\nPG/09/083/27667/British Heart Foundation/United Kingdom\nComment\n2010/04/17 06:00\nJ Nucl Med. 2010 May;51(5):667-8. doi: 10.2967/jnumed.109.072355. Epub 2010 Apr 15.", "page" : "667-668", "title" : "The role of 18F-FDG PET in aortic dissection", "type" : "article-journal", "volume" : "51" }, "uris" : [ "http://www.mendeley.com/documents/?uuid=49ef1879-427c-4aad-bb70-d5d31b2815f3" ] } ], "mendeley" : { "formattedCitation" : "118", "plainTextFormattedCitation" : "118", "previouslyFormattedCitation" : "118" }, "properties" : { }, "schema" : "https://github.com/citation-style-language/schema/raw/master/csl-citation.json" }118 On recent scanners, PET and CT are combined within the same gantry, enabling the co-registration of PET and CT data and accurate anatomical localization of the tracer uptake (FIG. 6).
Imaging AAA using PET poses challenges regarding the technique and the disease process. 18F-FDG uptake in AAA is nonspecific.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1007/s00259-014-2865-9", "ISSN" : "1619-7070", "PMID" : "25156330", "abstract" : "PURPOSE Aortic metabolic activity is suggested to correlate with presence and progression of aneurysmal disease, but has been inadequately studied. This study investigates the 2-[(18)F] fluoro-2-deoxy-D-glucose ((18)F-FDG) uptake in a population of infra-renal abdominal aortic aneurysms (AAA), compared to a matched non-aneurysmal control group. METHODS The Positron Emission Tomography - Computed Tomography (PET/CT) database was searched for infra-renal AAA. Exclusion criteria were prior repair, vasculitis, and saccular/mycotic thoracic or thoraco-abdominal aneurysms. Matching of 159 non-aneurysmal (<3 cm diameter) controls from the same population was assessed. Infra-renal aortic wall FDG uptake was assessed using visual analysis; maximum standardized uptake value (SUVmax) and target to background mediastinal blood pool ratio (TBR) were documented. Predictors of FDG uptake (age, sex, aortic diameter, hypertension, statin use, and diabetes) were assessed using univariate analysis. Follow-up questionnaires were sent to referring clinicians. RESULTS Aneurysms (n = 151) and controls (n = 159) were matched (p > 0.05) for age, sex, diabetes, hypertension, smoking status, statin use, and indication for PET/CT. Median aneurysm diameter was 5.0 cm (range 3.2-10.4). On visual analysis there was no significant difference in the overall numbers with increased visual uptake 24% (36/151) in the aneurysm group vs. 19% (30/159) in the controls, p = ns. SUVmax was slightly lower in the aneurysm group vs. controls (mean (2 SD) 1.75(0.79) vs. 1.84(0.58), p = 0.02). However there was no difference in TBR between the AAA group and controls (mean (2 SD) 1.03 (0.46) vs. 1.05(0.31), p = 0.36). During a median 18 (interquartile range 8-35) months' follow-up 20 were repaired and four were confirmed ruptured. CONCLUSIONS The level of metabolic activity as assessed by (18)F-FDG PET/CT in infra-renal AAA does not correlate with aortic size and does not differ between aneurysms and matched controls.", "author" : [ { "dropping-particle" : "", "family" : "Barwick", "given" : "Tara D.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Lyons", "given" : "O. T. A.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Mikhaeel", "given" : "N. G.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Waltham", "given" : "M.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "O\u2019Doherty", "given" : "M. J.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "European Journal of Nuclear Medicine and Molecular Imaging", "id" : "ITEM-1", "issue" : "12", "issued" : { "date-parts" : [ [ "2014", "12", "26" ] ] }, "page" : "2310-2318", "title" : "18F-FDG PET-CT uptake is a feature of both normal diameter and aneurysmal aortic wall and is not related to aneurysm size", "type" : "article-journal", "volume" : "41" }, "uris" : [ "http://www.mendeley.com/documents/?uuid=bf07f4dd-688a-31e3-9118-9922bc607ce8" ] } ], "mendeley" : { "formattedCitation" : "119", "plainTextFormattedCitation" : "119", "previouslyFormattedCitation" : "119" }, "properties" : { }, "schema" : "https://github.com/citation-style-language/schema/raw/master/csl-citation.json" }119 In addition a marked decrease in cell density in AAAsADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1007/s00259-011-1955-1", "ISBN" : "1619-7089 (Electronic) 1619-7070 (Linking)", "PMID" : "22012546", "abstract" : "PURPOSE: Conflicting results have been reported about the clinical value of fluorodeoxyglucose (FDG) imaging in predicting the risk of rupture of abdominal aortic aneurysm (AAA). The present study tests the hypothesis that FDG uptake is low in asymptomatic noninflammatory AAA due to the low cell density in aneurysmal walls. METHODS: Positron emission tomography (PET)/CT imaging was performed in 12 consecutive candidates for AAA surgical repair and in 12 age- and sex-matched controls. At intervention, aneurysmal walls were cut into three sequential blocks. Block A was frozen to cut three 5-mum slices for incubation with 2-3 MBq of FDG for 5 min. Block C was first incubated with the same tracer solution for the same time and subsequently frozen to cut three 5-mum slices. Autoradiographic images were coregistered with immunohistochemical pictures of cell density, type and DNA synthesis as assessed on block B. RESULTS: No visible uptake in abdominal aorta occurred in any patient or control subject. Immunohistochemistry documented a severe loss of wall structure, with low numbers of cells. Tracer retention directly correlated with overall cell density and with prevalence of cells synthesizing DNA. The metabolic nature of FDG uptake was confirmed by the selective effect of preliminary freezing that decreased tracer content by 90% in regions with high cell density and only by 34% in cold acellular areas. CONCLUSION: The loss of tissue structure and the marked decrease in cell density account for the low prevalence of positive findings at FDG PET imaging, at least in asymptomatic patients bearing AAAs whose diameter is close to surgical indication.", "author" : [ { "dropping-particle" : "", "family" : "Marini", "given" : "C", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Morbelli", "given" : "S", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Armonino", "given" : "R", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Spinella", "given" : "G", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Riondato", "given" : "M", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Massollo", "given" : "M", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Sarocchi", "given" : "F", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Pane", "given" : "B", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Augeri", "given" : "C", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Abete", "given" : "L", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Ghigliotti", "given" : "G", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Palmieri", "given" : "D", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Fiz", "given" : "F", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Cittadini", "given" : "G", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Fulcheri", "given" : "E", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Palombo", "given" : "D", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Sambuceti", "given" : "G", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Eur J Nucl Med Mol Imaging", "edition" : "2011/10/21", "id" : "ITEM-1", "issue" : "1", "issued" : { "date-parts" : [ [ "2012" ] ] }, "language" : "eng", "note" : "Marini, Cecilia\nMorbelli, Silvia\nArmonino, Riccardo\nSpinella, Giovanni\nRiondato, Mattia\nMassollo, Michela\nSarocchi, Francesca\nPane, Bianca\nAugeri, Carla\nAbete, Luca\nGhigliotti, Giorgio\nPalmieri, Daniela\nFiz, Francesco\nCittadini, Giuseppe\nFulcheri, Ezio\nPalombo, Domenico\nSambuceti, Gianmario\nGermany\nEuropean journal of nuclear medicine and molecular imaging\nEur J Nucl Med Mol Imaging. 2012 Jan;39(1):91-101. Epub 2011 Oct 20.", "page" : "91-101", "title" : "Direct relationship between cell density and FDG uptake in asymptomatic aortic aneurysm close to surgical threshold: an in vivo and in vitro study", "type" : "article-journal", "volume" : "39" }, "uris" : [ "http://www.mendeley.com/documents/?uuid=eb1298be-dd72-424c-b1e8-b9d192577b40" ] } ], "mendeley" : { "formattedCitation" : "120", "plainTextFormattedCitation" : "120", "previouslyFormattedCitation" : "120" }, "properties" : { }, "schema" : "https://github.com/citation-style-language/schema/raw/master/csl-citation.json" }120 and substantial background noise on PET images decrease the chance of having 18F-FDG uptake.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "S0890-5096(11)00510-3 [pii] 10.1016/j.avsg.2011.05.038", "ISBN" : "1615-5947 (Electronic) 0890-5096 (Linking)", "PMID" : "22197524", "abstract" : "BACKGROUND: To assess the prevalence of increased (18)F-fluorodeoxyglucose (FDG) uptake in aneurysmal walls, adopting a case-control approach in a population of asymptomatic patients with abdominal aortic aneurysm (AAA). METHODS: This study included 40 males (mean age: 74 years, range: 59-93 years), consecutive, white Caucasian patients, with asymptomatic infrarenal AAA. The mean diameter of AAA was 4.9 cm (range: 4.8-5.4 cm), detected by computed tomography (CT) scan. Control Subjects: 44 age-matched controls subjects (mean age: 71 years, range: 59-85 years, 24 males, 20 females) who were selected according to a case-control criterion among a population of patients without any clinical evidence of atherosclerotic disease. Patients and controls underwent simultaneous FDG-positron emission tomography (PET) and CT imaging from the skull base to the femoral neck by using an integrated PET/CT scanner. PET/CT studies were analysed both visually and quantitatively. For quantitative analysis, circular CT-based regions of interest (ROIs) were drawn on the AAA, on all the aortic segments, and on the large vessel included in the study (carotid, subclavian, and iliac arteries). FDG uptake was quantified by calculating the mean and maximum standardized uptake values (SUVs) within each ROI and normalizing for the blood-pool SUV to obtain the final target-to-background ratio. Arterial calcium load was graded according to a semiquantitative five-point scale based on calcification of the arterial ring. RESULTS: Metabolic activity in the aneurysmal aortic segment was even lower with respect to both the adjacent--nonaneurysmal--samples of patient group and the corresponding arterial segments of control subjects (P < 0.001 and P < 0.01, respectively). In visual analysis, no patients showed an increased focal uptake of degree adequate to identify the aneurysmal arterial wall. AAA patients showed significantly higher values of total calcium load (ACL) than controls in ascending aorta and subclavian and iliac arteries (P < 0.01), and only in AAA patient group, a significant correlation was present between values of ACL in both iliac arteries and abdominal aorta on one side and wall metabolic activity in the same arteries on the other (P < 0.05). CONCLUSIONS: In conclusion, our results suggest that FDG hot spot, as well an increased diffuse uptake of FDG, in PET/CT studies is an extremely rare finding in patients with AAA of diameter close to surgical indications.", "author" : [ { "dropping-particle" : "", "family" : "Palombo", "given" : "D", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Morbelli", "given" : "S", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Spinella", "given" : "G", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Pane", "given" : "B", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Marini", "given" : "C", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Rousas", "given" : "N", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Massollo", "given" : "M", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Cittadini", "given" : "G", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Camellino", "given" : "D", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Sambuceti", "given" : "G", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Ann Vasc Surg", "edition" : "2011/12/27", "id" : "ITEM-1", "issue" : "4", "issued" : { "date-parts" : [ [ "2012" ] ] }, "language" : "eng", "note" : "Palombo, Domenico\nMorbelli, Silvia\nSpinella, Giovanni\nPane, Bianca\nMarini, Cecilia\nRousas, Nikolaos\nMassollo, Michela\nCittadini, Giuseppe\nCamellino, Dario\nSambuceti, Gianmario\nComparative Study\nEvaluation Studies\nUnited States\nAnnals of vascular surgery\nAnn Vasc Surg. 2012 May;26(4):491-9. Epub 2011 Dec 23.", "page" : "491-499", "title" : "A positron emission tomography/computed tomography (PET/CT) evaluation of asymptomatic abdominal aortic aneurysms: another point of view", "type" : "article-journal", "volume" : "26" }, "uris" : [ "http://www.mendeley.com/documents/?uuid=e92a4d05-a082-416e-9802-14ba9434fffa" ] }, { "id" : "ITEM-2", "itemData" : { "DOI" : "10.1016/j.jvs.2012.02.024", "ISBN" : "1097-6809 (Electronic)\r0741-5214 (Linking)", "PMID" : "22854268", "abstract" : "OBJECTIVE: We hypothesized that the general inflammation observed in the wall of large, asymptomatic abdominal aortic aneurysms (AAAs) could be detected in vivo by 18-fluorodeoxglucose (FDG) positron-emission tomography (PET) and, if so, that this method could be used to study if active inflammation is an early pathogenetic finding in small AAAs detected by screening. METHODS: In this prospective clinical study, 12 men were examined with FDG-PET computed tomography. Seven had large asymptomatic AAAs (range, 52-66 mm) that required surgery, and five had small AAAs (range, 34-40 mm) under surveillance. In the surgery group, biopsy specimens were taken from the aneurysm wall for histologic examinations. RESULTS: Compared with normal segments of the aorta, liver, and blood and compared with healthy controls matched for age and sex, no increased FDG uptake, measured as standardized uptake value, was detected in any of the large or small AAAs. The SUV(mean) difference between infrarenal aorta and blood was -0.3 for cases and -0.1 for controls (P = .06). The corresponding differences between the infrarenal aorta and liver was -0.8 and -0.8 (P = .91) and between infrarenal aorta and suprarenal aorta was -0.2 and -0.1 for cases and controls, respectively (P = .20). The histologic examination of the aneurysm walls showed high inflammatory cell infiltration with T lymphocytes, B lymphocytes, and macrophages. CONCLUSIONS: The chronic inflammation observed in the wall of asymptomatic AAAs was not sufficiently metabolically active to result in an increased glucose metabolism detectable by FDG-PET by means of this standard protocol. To study the importance of inflammation in the pathogenesis of AAAs in vivo, PET tracers other than FDG need to be developed.", "author" : [ { "dropping-particle" : "", "family" : "Tegler", "given" : "G", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Ericson", "given" : "K", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Sorensen", "given" : "J", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Bjorck", "given" : "M", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Wanhainen", "given" : "A", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "J Vasc Surg", "id" : "ITEM-2", "issue" : "3", "issued" : { "date-parts" : [ [ "2012" ] ] }, "note" : "Tegler, Gustaf\nEricson, Katharina\nSorensen, Jens\nBjorck, Martin\nWanhainen, Anders\neng\nResearch Support, Non-U.S. Gov't\n2012/08/03 06:00\nJ Vasc Surg. 2012 Sep;56(3):802-7. doi: 10.1016/j.jvs.2012.02.024. Epub 2012 Jul 31.", "page" : "802-807", "title" : "Inflammation in the walls of asymptomatic abdominal aortic aneurysms is not associated with increased metabolic activity detectable by 18-fluorodeoxglucose positron-emission tomography", "type" : "article-journal", "volume" : "56" }, "uris" : [ "http://www.mendeley.com/documents/?uuid=5e7c61b9-3661-4ec1-a052-f064fa31ea19" ] } ], "mendeley" : { "formattedCitation" : "121,122", "plainTextFormattedCitation" : "121,122", "previouslyFormattedCitation" : "121,122" }, "properties" : { }, "schema" : "https://github.com/citation-style-language/schema/raw/master/csl-citation.json" }121,122 Despite these challenges, several studies have shown that 18F-FDG uptake in AAA is associated with inflammatory and phagocytic cell infiltrates,ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1053/ejvs.2002.1646 S1078588402916461 [pii]", "ISBN" : "1078-5884 (Print) 1078-5884 (Linking)", "PMID" : "12027471", "abstract" : "BACKGROUND: aneurysmal disease is associated with an inflammatory cell infiltrate and enzymatic degradation of the vessel wall. AIM OF THE STUDY: to detect increased metabolic activity in abdominal aortic aneurysms (AAA) by means of positron emission tomography (PET-imaging). STUDY DESIGN: twenty-six patients with AAA underwent PET-imaging. RESULTS: in ten patients, PET-imaging revealed increased fluoro-deoxy-glucose (18-FDG) uptake at the level of the aneurysm. Patients with positive PET-imaging had one or more of the following elements in their clinical history: history of recent non-aortic surgery (n = 4), a painful inflammatory aortic aneurysm (n = 2), moderate low back pain (n = 2), rapid (> 2;5 mm in 6 months) expansion (n = 4), discovery by PET-scan of a previously undiagnosed lung cancer (n = 3) or parotid tumour (n = 1). Five patients with a positive PET scan required urgent surgery within two to 30 days. Among the 16 patients with negative PET-imaging of their aneurysm, only one had recent non-aortic surgery, none of them required urgent surgery, only two had a rapidly expanding AAA, and in only one patient, PET-imaging revealed an unknown lung cancer. CONCLUSION: these data suggest a possible association between increased 18-FDG uptake and AAA expansion and rupture.", "author" : [ { "dropping-particle" : "", "family" : "Sakalihasan", "given" : "N", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Damme", "given" : "H", "non-dropping-particle" : "Van", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Gomez", "given" : "P", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Rigo", "given" : "P", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Lapiere", "given" : "C M", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Nusgens", "given" : "B", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Limet", "given" : "R", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Eur J Vasc Endovasc Surg", "edition" : "2002/05/25", "id" : "ITEM-1", "issue" : "5", "issued" : { "date-parts" : [ [ "2002" ] ] }, "language" : "eng", "note" : "Sakalihasan, N\nVan Damme, H\nGomez, P\nRigo, P\nLapiere, C M\nNusgens, B\nLimet, R\nEvaluation Studies\nEngland\nEuropean journal of vascular and endovascular surgery : the official journal of the European Society for Vascular Surgery\nEur J Vasc Endovasc Surg. 2002 May;23(5):431-6.", "page" : "431-436", "title" : "Positron emission tomography (PET) evaluation of abdominal aortic aneurysm (AAA)", "type" : "article-journal", "volume" : "23" }, "uris" : [ "http://www.mendeley.com/documents/?uuid=e67a9e23-2644-410e-bdc8-ecd397b8acee" ] }, { "id" : "ITEM-2", "itemData" : { "DOI" : "00003072-200505000-00014 [pii]", "ISBN" : "0363-9762 (Print) 0363-9762 (Linking)", "PMID" : "15827408", "abstract" : "A 68-year-old man was hospitalized for unstable angina and underwent emergency coronary artery bypass surgery. During the operation, a pulsatile large abdominal aortic aneurysm (AAA) was discovered. To define the optimal treatment of the abdominal aneurysm, after bypass surgery, CT scans and positron emission tomography (PET) were performed, as we routinely do. PET imaging combined with immunohistologic examination showed a region of increased F-18 FDG uptake corresponding to an inflammatory infiltrate in the aortic wall in contrast to the thrombus in the aneurysm (devoid of inflammatory cells). The luminal area showed midlevel F-18 FDG uptake corresponding to circulating mediators.", "author" : [ { "dropping-particle" : "", "family" : "Defawe", "given" : "O D", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Hustinx", "given" : "R", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Defraigne", "given" : "J O", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Limet", "given" : "R", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Sakalihasan", "given" : "N", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Clin Nucl Med", "edition" : "2005/04/14", "id" : "ITEM-2", "issue" : "5", "issued" : { "date-parts" : [ [ "2005" ] ] }, "language" : "eng", "note" : "Defawe, Olivier Damien\nHustinx, Roland\nDefraigne, Jean Olivier\nLimet, Raymond\nSakalihasan, Natzi\nCase Reports\nUnited States\nClinical nuclear medicine\nClin Nucl Med. 2005 May;30(5):340-1.", "page" : "340-341", "title" : "Distribution of F-18 fluorodeoxyglucose (F-18 FDG) in abdominal aortic aneurysm: high accumulation in macrophages seen on PET imaging and immunohistology", "type" : "article-journal", "volume" : "30" }, "uris" : [ "http://www.mendeley.com/documents/?uuid=c333303c-5da1-41f1-a7d5-a25ee35f4ed9" ] }, { "id" : "ITEM-3", "itemData" : { "DOI" : "08-2447 [pii] 10.1583/08-2447.1", "ISBN" : "1526-6028 (Print) 1526-6028 (Linking)", "PMID" : "18729562", "abstract" : "PURPOSE: To study the potential of integrated positron emission tomography and computed tomography (PET/CT) to identify aneurysm wall inflammation. METHODS: The level of F18-fluorodeoxyglucose (FDG) uptake was studied in aneurysmal and normal-sized aortas of 34 male patients [17 with abdominal aortic aneurysm (AAA) and 17 age-matched controls] identified in a database of 278 consecutive patients evaluated for staging of primary lung cancer. The maximal standardized uptake value (SUV) was calculated to quantify FDG uptake in the AAA wall. RESULTS: AAAs showed significantly higher FDG uptake than the normal-sized aorta in age-matched controls (SUV 2.52+/-0.52 versus 1.78+/-0.45, respectively; p<0.001). The level of FDG uptake did not correlate with maximal aneurysm diameter (r=0.09; 95% CI -0.42 to 0.56; p=0.7). CONCLUSION: FDG-PET/CT is a promising technique to identify inflammation of the aneurysm wall. Irrespective of aneurysm diameter, asymptomatic AAAs show more FDG uptake and more inflammatory activity in the wall than the non-dilated abdominal aorta of sex/age-matched controls. Future studies will be directed at the predictive value of increased FDG uptake for aneurysm wall strength, rupture risk, and the utility of FDG-PET/CT in assessing the effect of medical interventions.", "author" : [ { "dropping-particle" : "", "family" : "Truijers", "given" : "M", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Kurvers", "given" : "H A", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Bredie", "given" : "S J", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Oyen", "given" : "W J", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Blankensteijn", "given" : "J D", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "J Endovasc Ther", "edition" : "2008/08/30", "id" : "ITEM-3", "issue" : "4", "issued" : { "date-parts" : [ [ "2008" ] ] }, "language" : "eng", "note" : "Truijers, Maarten\nKurvers, Harrie A J M\nBredie, Sebastian J H\nOyen, Wim J G\nBlankensteijn, Jan D\nUnited States\nJournal of endovascular therapy : an official journal of the International Society of Endovascular Specialists\nJ Endovasc Ther. 2008 Aug;15(4):462-7.", "page" : "462-467", "title" : "In vivo imaging of abdominal aortic aneurysms: increased FDG uptake suggests inflammation in the aneurysm wall", "type" : "article-journal", "volume" : "15" }, "uris" : [ "http://www.mendeley.com/documents/?uuid=e8a12057-a056-48d6-9144-de18bef8fa5c" ] }, { "id" : "ITEM-4", "itemData" : { "DOI" : "S1078-5884(08)00696-5 [pii] 10.1016/j.ejvs.2008.12.016", "ISBN" : "1532-2165 (Electronic) 1078-5884 (Linking)", "PMID" : "19217326", "abstract" : "OBJECTIVES: Abdominal aortic aneurysms (AAAs) are associated with an inflammatory cell infiltrate and enzymatic degradation of the vessel wall. The aim of this study was to detect increased metabolic activity in the wall of the AAA with 18F-fluorodeoxyglucose ((18)F-FDG), mediated by glucose transporter protein (GLUTs), using a dedicated hybrid PET/64-detector CT. DESIGN, METHOD AND MATERIALS: 14 patients (All male, mean age 73.6 years, range 61-82) with AAA under surveillance underwent PET/CT scanning with 175 MBq of intravenous (18)F-FDG. The maximum aneurysm diameter and calcification score were determined on the attenuation correction CT. A volume of interest was placed on the aneurysm sac and the maximum Standardised Uptake Value (SUV(max)) measured. RESULTS: The mean aneurysm diameter was 5.4 cm (SD+/-0.8). Two aneurysms had the CT characteristics of inflammatory aneurysms. Twelve aneurysms showed increased FDG uptake (SUV(max)>2.5). There was no significant difference in FDG uptake between heavily calcified aneurysms and non-heavily calcified aneurysms (t-test). There was a significant increase in the FDG uptake in the two inflammatory aneurysms compared to the other twelve aneurysms (t-test; P=0.04). CONCLUSION: The findings in this study offer in vivo evidence that the AAA wall shows increased glucose metabolism, mediated by the GLUTs: this increased metabolic activity as detected by PET/CT may be present in most AAAs.", "author" : [ { "dropping-particle" : "", "family" : "Kotze", "given" : "C W", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Menezes", "given" : "L J", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Endozo", "given" : "R", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Groves", "given" : "A M", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Ell", "given" : "P J", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Yusuf", "given" : "S W", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Eur J Vasc Endovasc Surg", "edition" : "2009/02/17", "id" : "ITEM-4", "issue" : "1", "issued" : { "date-parts" : [ [ "2009" ] ] }, "language" : "eng", "note" : "Kotze, C W\nMenezes, L J\nEndozo, R\nGroves, A M\nEll, P J\nYusuf, S W\nComparative Study\nResearch Support, Non-U.S. Gov't\nEngland\nEuropean journal of vascular and endovascular surgery : the official journal of the European Society for Vascular Surgery\nEur J Vasc Endovasc Surg. 2009 Jul;38(1):93-9. Epub 2009 Feb 12.", "page" : "93-99", "title" : "Increased metabolic activity in abdominal aortic aneurysm detected by 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography/computed tomography (PET/CT)", "type" : "article-journal", "volume" : "38" }, "uris" : [ "http://www.mendeley.com/documents/?uuid=8c592030-2bc3-49c7-9695-399539b5a770" ] }, { "id" : "ITEM-5", "itemData" : { "DOI" : "10.1161/01.ATV.0000237605.25666.13", "ISBN" : "1524-4636 (Electronic)\r1079-5642 (Linking)", "PMID" : "16857952", "abstract" : "BACKGROUND: The mural thrombus of abdominal aortic aneurysms (AAA) is involved in aneurysm progression via several interdependent biological processes including platelet activation. 99mTc-annexin V (ANX) is a scintigraphic tracer that binds to phosphatidylserine exposed on activated platelets and apoptotic cells. Here, we evaluated the potential of ANX imaging to assess mural thrombus biological activity in an experimental AAA model. The clinical applicability was further tested ex vivo on human samples of excised AAA thrombi. METHODS AND RESULTS: Experimental AAA was created by infusing elastase into infrarenal abdominal aorta in 17 rats, and 6 sham-operated rats were used as controls. Abdominal ANX scintigraphy was performed 2 weeks later followed by quantitative autoradiography and histological studies. Among the 13 rats which developed AAA, 11 displayed intense ANX uptake within AAA by scintigraphy. ANX uptake in the aneurysms on planar and single-photon emission computed tomography (SPECT) imaging was higher than that observed in infrarenal aorta of sham-operated controls (target/background ratio: 5.7+/-0.9 versus 1.33+/-0.21; P<0.005 for SPECT). Aneurysm-to-background activity ratios obtained by scintigraphy correlated with ANX activity in corresponding autoradiograms (R=0.69; P<0.02). This activity was located in the thrombus area where activated platelets and polymorphonuclear leukocytes accumulated. Similar patterns were also found in all of the 7 human AAA thrombi harvested during surgery. CONCLUSIONS: ANX imaging may assess mural thrombus renewal activity linked to permanent flowing blood interface.", "author" : [ { "dropping-particle" : "", "family" : "Sarda-Mantel", "given" : "L", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Coutard", "given" : "M", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Rouzet", "given" : "F", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Raguin", "given" : "O", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Vrigneaud", "given" : "J M", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Hervatin", "given" : "F", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Martet", "given" : "G", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Touat", "given" : "Z", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Merlet", "given" : "P", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Guludec", "given" : "D", "non-dropping-particle" : "Le", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Michel", "given" : "J B", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Arterioscler Thromb Vasc Biol", "id" : "ITEM-5", "issue" : "9", "issued" : { "date-parts" : [ [ "2006" ] ] }, "note" : "Sarda-Mantel, Laure\nCoutard, Michele\nRouzet, Francois\nRaguin, Olivier\nVrigneaud, Jean-Marc\nHervatin, Florence\nMartet, Genevieve\nTouat, Ziad\nMerlet, Pascal\nLe Guludec, Dominique\nMichel, Jean-Baptiste\neng\nResearch Support, Non-U.S. Gov't\n2006/07/22 09:00\nArterioscler Thromb Vasc Biol. 2006 Sep;26(9):2153-9. doi: 10.1161/01.ATV.0000237605.25666.13. Epub 2006 Jul 20.", "page" : "2153-2159", "title" : "99mTc-annexin-V functional imaging of luminal thrombus activity in abdominal aortic aneurysms", "type" : "article-journal", "volume" : "26" }, "uris" : [ "http://www.mendeley.com/documents/?uuid=4cf73cf3-d2a2-48fe-a540-1d231b1c9512" ] } ], "mendeley" : { "formattedCitation" : "123\u2013127", "plainTextFormattedCitation" : "123\u2013127", "previouslyFormattedCitation" : "123\u2013127" }, "properties" : { }, "schema" : "https://github.com/citation-style-language/schema/raw/master/csl-citation.json" }123127 proteolytic activity by MMPs,ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "00003072-200505000-00014 [pii]", "ISBN" : "0363-9762 (Print) 0363-9762 (Linking)", "PMID" : "15827408", "abstract" : "A 68-year-old man was hospitalized for unstable angina and underwent emergency coronary artery bypass surgery. During the operation, a pulsatile large abdominal aortic aneurysm (AAA) was discovered. To define the optimal treatment of the abdominal aneurysm, after bypass surgery, CT scans and positron emission tomography (PET) were performed, as we routinely do. PET imaging combined with immunohistologic examination showed a region of increased F-18 FDG uptake corresponding to an inflammatory infiltrate in the aortic wall in contrast to the thrombus in the aneurysm (devoid of inflammatory cells). The luminal area showed midlevel F-18 FDG uptake corresponding to circulating mediators.", "author" : [ { "dropping-particle" : "", "family" : "Defawe", "given" : "O D", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Hustinx", "given" : "R", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Defraigne", "given" : "J O", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Limet", "given" : "R", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Sakalihasan", "given" : "N", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Clin Nucl Med", "edition" : "2005/04/14", "id" : "ITEM-1", "issue" : "5", "issued" : { "date-parts" : [ [ "2005" ] ] }, "language" : "eng", "note" : "Defawe, Olivier Damien\nHustinx, Roland\nDefraigne, Jean Olivier\nLimet, Raymond\nSakalihasan, Natzi\nCase Reports\nUnited States\nClinical nuclear medicine\nClin Nucl Med. 2005 May;30(5):340-1.", "page" : "340-341", "title" : "Distribution of F-18 fluorodeoxyglucose (F-18 FDG) in abdominal aortic aneurysm: high accumulation in macrophages seen on PET imaging and immunohistology", "type" : "article-journal", "volume" : "30" }, "uris" : [ "http://www.mendeley.com/documents/?uuid=c333303c-5da1-41f1-a7d5-a25ee35f4ed9" ] }, { "id" : "ITEM-2", "itemData" : { "DOI" : "10.1007/s10554-012-0090-9", "ISBN" : "1875-8312 (Electronic) 1569-5794 (Linking)", "PMID" : "22772434", "abstract" : "Inflammatory-proteolytic processes in the vessel wall are essential in the pathophysiology of abdominal aortic aneurysm (AAA). It has been demonstrated that, (18)F-FDG-PET/CT may be useful for detection of pathological wall metabolism and therefore risk stratification. Quantification of the FDG-uptake in AAA wall is hampered by partial-volume (PV)-effects. For correction and accurate quantitative (18)F-FDG-uptake analysis we designed and validated a novel IDL-based software in correlation to phantom studies, histopathology and clinical presentation of AAA patients. For in vivo studies 23 patients with symptomatic and asymptomatic AAA underwent (18)F-FDG-PET/CT before surgery. In areas with (18)F-FDG-uptake the maximum and mean standardized uptake values in the vessel wall with (PVC-SUV(max), PVC-SUV(mean)) and without (SUV(max), SUV(mean)) PV-correction were determined. Results were correlated with clinical presentation, corresponding macrophage-infiltration and MMP-2- and -9-expression in surgical specimens. In patients, SUV(max), SUV(mean) as well as PVC-SUV(max) or PVC-SUV(mean) enabled a highly significant (p < 0.005) discrimination of symptomatic and asymptomatic AAA. Uncorrected and corrected SUVs showed comparable correlations with macrophage-infiltration and MMP-9 expression. No correlation of (18)F-FDG-uptake and MMP-2 was found. In vivo correlations of detected FDG-uptake with clinical and histological results showed comparable results for corrected and uncorrected SUVs. PV-correction is not mandatory for qualitative clinical assessment of glucose metabolism in the vessel wall of AAA-patients but may be necessary to establish quantitative cut off values to stratify patients for aneurysm repair.", "author" : [ { "dropping-particle" : "", "family" : "Reeps", "given" : "C", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Bundschuh", "given" : "R A", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Pellisek", "given" : "J", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Herz", "given" : "M", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Marwick", "given" : "S", "non-dropping-particle" : "van", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Schwaiger", "given" : "M", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Eckstein", "given" : "H H", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Nekolla", "given" : "S G", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Essler", "given" : "M", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Int J Cardiovasc Imaging", "edition" : "2012/07/10", "id" : "ITEM-2", "issued" : { "date-parts" : [ [ "2012" ] ] }, "language" : "Eng", "note" : "Reeps, Christian\nBundschuh, Ralph A\nPellisek, Jaroslav\nHerz, Michael\nvan Marwick, Sandra\nSchwaiger, Markus\nEckstein, Hans-Henning\nNekolla, Stephan G\nEssler, Markus\nJournal article\nThe international journal of cardiovascular imaging\nInt J Cardiovasc Imaging. 2012 Jul 7.", "title" : "Quantitative assessment of glucose metabolism in the vessel wall of abdominal aortic aneurysms: correlation with histology and role of partial volume correction", "type" : "article-journal" }, "uris" : [ "http://www.mendeley.com/documents/?uuid=85f372d8-2fde-4ad5-a465-037cb6e44b8b" ] } ], "mendeley" : { "formattedCitation" : "124,128", "plainTextFormattedCitation" : "124,128", "previouslyFormattedCitation" : "124,128" }, "properties" : { }, "schema" : "https://github.com/citation-style-language/schema/raw/master/csl-citation.json" }124,128 and cellular and molecular signaling preceding rupture.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "ISSN" : "1535-5667", "PMID" : "24009278", "abstract" : "UNLABELLED: Rupture of abdominal aortic aneurysms (AAAs) leads to a significant morbidity and mortality in aging populations, and its prediction would be most beneficial to public health. Spots positive for uptake of (18)F-FDG detected by PET are found in 12% of AAA patients (PET+), who are most often symptomatic and at high rupture risk. Comparing the (18)F-FDG-positive site with a negative site from the same aneurysm and with samples collected from AAA patients with no (18)F-FDG uptake should allow the discrimination of biologic alterations that would help in identifying markers predictive of rupture.\\n\\nMETHODS: Biopsies of the AAA wall were obtained from patients with no (18)F-FDG uptake (PET0, n = 10) and from PET+ patients (n = 8), both at the site positive for uptake and at a distant negative site of the aneurysmal wall. Samples were analyzed by immunohistochemistry, quantitative real-time polymerase chain reaction, and zymography.\\n\\nRESULTS: The sites of the aneurysmal wall with a positive (18)F-FDG uptake were characterized by a strikingly increased number of adventitial inflammatory cells, highly proliferative, and by a drastic reduction of smooth muscle cells (SMCs) in the media as compared with their negative counterpart and with the PET0 wall. The expression of a series of genes involved in the maintenance and remodeling of the wall was significantly modified in the negative sites of PET+, compared with the PET0 wall, suggesting a systemic alteration of the aneurysmal wall. Furthermore, a striking increase of several matrix metalloproteinases (MMPs), notably the MMP1 and MMP13 collagenases, was observed in the positive sites, mainly in the adventitia. Moreover, PET+ patients were characterized by a higher circulating C-reactive protein.\\n\\nCONCLUSION: Positive (18)F-FDG uptake in the aneurysmal wall is associated with an active inflammatory process characterized by a dense infiltrate of proliferating leukocytes in the adventitia and an increased circulating C-reactive protein. Moreover, a loss of SMC in the media and alterations of the expression of genes involved in the remodeling of adventitia and collagen degradation potentially participate in the weakening of the aneurysmal wall preceding rupture.", "author" : [ { "dropping-particle" : "", "family" : "Courtois", "given" : "Audrey", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "V", "family" : "Nusgens", "given" : "Betty", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Hustinx", "given" : "Roland", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Namur", "given" : "Gauthier", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Gomez", "given" : "Pierre", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Somja", "given" : "Joan", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Defraigne", "given" : "Jean-Olivier", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Delvenne", "given" : "Philippe", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Michel", "given" : "Jean-Baptiste", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Colige", "given" : "Alain C", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Sakalihasan", "given" : "Natzi", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Journal of nuclear medicine : official publication, Society of Nuclear Medicine", "id" : "ITEM-1", "issue" : "10", "issued" : { "date-parts" : [ [ "2013" ] ] }, "page" : "1740-7", "title" : "18F-FDG uptake assessed by PET/CT in abdominal aortic aneurysms is associated with cellular and molecular alterations prefacing wall deterioration and rupture.", "type" : "article-journal", "volume" : "54" }, "uris" : [ "http://www.mendeley.com/documents/?uuid=5350ce54-d0dc-42ae-ab55-8ace46cf578a" ] } ], "mendeley" : { "formattedCitation" : "129", "plainTextFormattedCitation" : "129", "previouslyFormattedCitation" : "129" }, "properties" : { }, "schema" : "https://github.com/citation-style-language/schema/raw/master/csl-citation.json" }129
The ability of iron oxide to alter the MRI signal provides another option for functional imaging, as iron oxides are specifically phagocytized by the reticulo-endothelial system (mainly by macrophages).ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1148/radiol.09090657", "ISBN" : "1527-1315 (Electronic)\r0033-8419 (Linking)", "PMID" : "20177108", "abstract" : "PURPOSE: To prospectively determine if superparamagnetic iron oxide (SPIO)-enhanced magnetic resonance (MR) imaging could help visualize leukocyte phagocytic activities in human abdominal aortic aneurysms (AAAs). MATERIALS AND METHODS: This study was approved by the institutional ethics committee; all patients gave informed consent. Preoperative MR imaging data, including unenhanced and SPIO-enhanced T1-, T2*-, and T2-weighted transverse images of the entire AAA, obtained 1 hour after contrast enhancement from 15 patients (mean age, 72.7 years +/- 8.2; range, 60-83 years), 10 men (mean age, 73.5 years +/- 7.9; range, 60-83 years) and five women (mean age, 71.2 years +/- 9.4; range 60-82), were retrospectively evaluated. Morphologic appearance and semiquantitative and contrast-to-noise ratio (CNR) analyses of the thrombi were performed. Thrombi were analyzed semiquantitatively at microscopy after staining with hematoxylin-eosin, CD68, and CD66b. Levels of promatrix metalloproteinase (pro-MMP)-2 and pro-MMP-9, MMP-2 and MMP-9, and their mRNA located in the thrombus were assessed by using zymography and quantitative reverse transcriptase polymerase chain reaction analysis. Nonparametric statistics of the Spearman rank correlation were calculated to evaluate correlations between the aneurysm thrombus signal level decrease after SPIO and the levels of CD68(+), CD66b(+) cells, pro-MMP-2 and pro-MMP-9, MMP-2 and MMP-9, and MMP-9 mRNA. RESULTS: The pre-SPIO CNRs in the luminal sublayer of the thrombus and the deeper thrombus were -10.20 +/- 12.69 and -5.68 +/-10.38, respectively. After SPIO, the CNRs decreased to -21.34 +/-13.07 (P < .001) and -12.44 +/- 14.56, respectively (P < .012). There was a significant linear correlation between the thrombus signal level decrease and the levels of CD68(+) and CD66b(+) cells, pro-MMP-9, and MMP-9 mRNA (P < .05). CONCLUSION: MR imaging allows in vivo demonstration of SPIO uptake at the luminal interface of the thrombus. This uptake is correlated to the abundance of leukocytes. SUPPLEMENTAL MATERIAL: http://radiology.rsna.org/lookup/suppl/doi:10.1148/radiol.09090657/-/DC1.", "author" : [ { "dropping-particle" : "", "family" : "Nchimi", "given" : "A", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Defawe", "given" : "O", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Brisbois", "given" : "D", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Broussaud", "given" : "T K", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Defraigne", "given" : "J O", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Magotteaux", "given" : "P", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Massart", "given" : "B", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Serfaty", "given" : "J M", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Houard", "given" : "X", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Michel", "given" : "J B", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Sakalihasan", "given" : "N", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Radiology", "id" : "ITEM-1", "issue" : "3", "issued" : { "date-parts" : [ [ "2010" ] ] }, "note" : "Nchimi, Alain\nDefawe, Olivier\nBrisbois, Denis\nBroussaud, Thomas K Y\nDefraigne, Jean-Olivier\nMagotteaux, Paul\nMassart, Brigitte\nSerfaty, Jean-Michel\nHouard, Xavier\nMichel, Jean-Baptiste\nSakalihasan, Natzi\neng\nResearch Support, Non-U.S. Gov't\n2010/02/24 06:00\nRadiology. 2010 Mar;254(3):973-81. doi: 10.1148/radiol.09090657.", "page" : "973-981", "title" : "MR imaging of iron phagocytosis in intraluminal thrombi of abdominal aortic aneurysms in humans", "type" : "article-journal", "volume" : "254" }, "uris" : [ "http://www.mendeley.com/documents/?uuid=aec28773-9d58-474f-bf93-59c15cafd34c" ] }, { "id" : "ITEM-2", "itemData" : { "DOI" : "10.3389/fcvm.2017.00016", "ISBN" : "2297-055X (Print)\r2297-055X (Linking)", "PMID" : "28386544", "abstract" : "Abdominal aortic aneurysm (AAA) is a degenerative disease of the aorta common in adults older than 65 years of age. AAA is usually imaged using ultrasound or computed tomography. Molecular imaging technologies employing nanoparticles (NPs) have been proposed as novel ways to quantify pathological processes, such as inflammation, within AAAs as a means to identify the risk of rapid progression or rupture. This article reviews the current evidence supporting the role of NP-based imaging in the management of AAA. Currently, ultrasmall superparamagnetic NPs enhanced magnetic resonance imaging appears to hold the greatest potential for imaging macrophage-mediated inflammation in human AAA.", "author" : [ { "dropping-particle" : "", "family" : "Emeto", "given" : "T I", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Alele", "given" : "F O", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Smith", "given" : "A M", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Smith", "given" : "F M", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Dougan", "given" : "T", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Golledge", "given" : "J", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Front Cardiovasc Med", "id" : "ITEM-2", "issued" : { "date-parts" : [ [ "2017" ] ] }, "note" : "Emeto, Theophilus I\nAlele, Faith O\nSmith, Amy M\nSmith, Felicity M\nDougan, Tammy\nGolledge, Jonathan\neng\nReview\nSwitzerland\n2017/04/08 06:00\nFront Cardiovasc Med. 2017 Mar 23;4:16. doi: 10.3389/fcvm.2017.00016. eCollection 2017.", "page" : "16", "title" : "Use of Nanoparticles As Contrast Agents for the Functional and Molecular Imaging of Abdominal Aortic Aneurysm", "type" : "article-journal", "volume" : "4" }, "uris" : [ "http://www.mendeley.com/documents/?uuid=fed3157a-b190-47f7-bc08-349a0d6468f9" ] } ], "mendeley" : { "formattedCitation" : "130,131", "plainTextFormattedCitation" : "130,131", "previouslyFormattedCitation" : "130,131" }, "properties" : { }, "schema" : "https://github.com/citation-style-language/schema/raw/master/csl-citation.json" }130,131 MRI offers other opportunities for functional assessment of AAA, one of which evaluates the movement of water molecules in tissues: the Diffusion-Weighted Imaging (DWI). As 18F-FDG PET, DWI is sensitive to cellular density. Comparison between DWI and 18F-FDG PET has so far been reported only once in a patient with an aortic arch aneurysm.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.12945/j.aorta.2013.13-022", "ISBN" : "2325-4637 (Print)\r2325-4637 (Linking)", "PMID" : "26798694", "abstract" : "Diffusion-weighted MRI (DW-MRI) and (18)F-fluorodeoxyglucose positron emission tomography (FDG-PET) findings are described in a patient with a thoracic aortic aneurysm. Both examinations have the ability to noninvasively assess biological processes associated with aneurysm instability and therefore to potentially impact clinical decision-making regardless of the vessel size. Despite similarities between images on both techniques, FDG-PET evaluates glycolysis, while DW-MRI evaluates cell density, edema, and perfusion. Longitudinal studies including larger patient numbers are needed to investigate the temporal continuum and clinical significance of these findings.", "author" : [ { "dropping-particle" : "", "family" : "Nchimi", "given" : "A", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Couvreur", "given" : "T", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Meunier", "given" : "B", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Sakalihasan", "given" : "N", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Aorta (Stamford)", "id" : "ITEM-1", "issue" : "3", "issued" : { "date-parts" : [ [ "2013" ] ] }, "note" : "Nchimi, Alain\nCouvreur, Thierry\nMeunier, Benoit\nSakalihasan, Natzi\neng\nStamford, Conn.\n2013/08/01 00:00\nAorta (Stamford). 2013 Aug 1;1(3):198-201. doi: 10.12945/j.aorta.2013.13-022. eCollection 2013 Aug.", "page" : "198-201", "title" : "Magnetic Resonance Imaging Findings in a Positron Emission Tomography-Positive Thoracic Aortic Aneurysm", "type" : "article-journal", "volume" : "1" }, "uris" : [ "http://www.mendeley.com/documents/?uuid=d178ac2b-5b0e-4e42-b5d2-960323a4b4be" ] } ], "mendeley" : { "formattedCitation" : "132", "plainTextFormattedCitation" : "132", "previouslyFormattedCitation" : "132" }, "properties" : { }, "schema" : "https://github.com/citation-style-language/schema/raw/master/csl-citation.json" }132 MRI can also be used to evaluate periaortic neoangiogenesis as a marker of instability.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1002/jmri.24302", "ISBN" : "1522-2586 (Electronic)\r1053-1807 (Linking)", "PMID" : "24151142", "abstract" : "PURPOSE: To investigate the feasibility and reproducibility of dynamic contrast-enhanced MRI (DCE-MRI) to quantify abdominal aortic aneurysm (AAA) vessel wall enhancement dynamics which may reflect the amount of wall microvasculature. AAA vessel wall microvasculature has been linked with aneurysm progression and rupture. MATERIALS AND METHODS: Thirty patients with AAA underwent DCE-MRI at 1.5 Tesla. Enhancement dynamics of the aneurysm wall were quantified in regions-of-interest (ROIs) in the vessel wall by calculating the transfer constant (K(trans) ) using pharmacokinetic modeling and the area-under-gadolinium-curve (AUC). To assess reproducibility, 10 patients were imaged twice on different occasions. ROIs were drawn by two independent observers. The intraclass correlation coefficients (ICC) and coefficients of variation (CV) were determined to investigate intra-, interobserver, and interscan variability. RESULTS: Twenty-eight analyzable MR examinations were included for pharmacokinetic analysis after excluding two examinations due to severe motion artifacts. Intra-, interobserver, and interscan variability for K(trans) were small (all ICC > 0.90, CV < 14%) as well as for AUC measurements (all ICC > 0.88, CV < 23%). CONCLUSION: Quantitative analysis of AAA vessel wall enhancement dynamics with DCE-MRI is feasible and reproducible.", "author" : [ { "dropping-particle" : "", "family" : "Nguyen", "given" : "V L", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Backes", "given" : "W H", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Kooi", "given" : "M E", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Wishaupt", "given" : "M C", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Hellenthal", "given" : "F A", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Bosboom", "given" : "E M", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Geest", "given" : "R J", "non-dropping-particle" : "van der", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Schurink", "given" : "G W", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Leiner", "given" : "T", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "J Magn Reson Imaging", "id" : "ITEM-1", "issue" : "6", "issued" : { "date-parts" : [ [ "2014" ] ] }, "note" : "Nguyen, V Lai\nBackes, Walter H\nKooi, M Eline\nWishaupt, Mirthe C J\nHellenthal, Femke A M V I\nBosboom, E Marielle H\nvan der Geest, Rob J\nSchurink, Geert Willem H\nLeiner, Tim\neng\n2013/10/24 06:00\nJ Magn Reson Imaging. 2014 Jun;39(6):1449-56. doi: 10.1002/jmri.24302. Epub 2013 Oct 22.", "page" : "1449-1456", "title" : "Quantification of abdominal aortic aneurysm wall enhancement with dynamic contrast-enhanced MRI: feasibility, reproducibility, and initial experience", "type" : "article-journal", "volume" : "39" }, "uris" : [ "http://www.mendeley.com/documents/?uuid=184588a4-6df7-456c-bb1d-f5f034d2084e" ] }, { "id" : "ITEM-2", "itemData" : { "DOI" : "10.1371/journal.pone.0075173", "ISBN" : "1932-6203 (Electronic)\r1932-6203 (Linking)", "PMID" : "24098370", "abstract" : "PURPOSE: Increased microvascularization of the abdominal aortic aneurysm (AAA) vessel wall has been related to AAA progression and rupture. The aim of this study was to compare the suitability of three pharmacokinetic models to describe AAA vessel wall enhancement using dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI). MATERIALS AND METHODS: Patients with AAA underwent DCE-MRI at 1.5 Tesla. The volume transfer constant (K(trans) ), which reflects microvascular flow, permeability and surface area, was calculated by fitting the blood and aneurysm vessel wall gadolinium concentration curves. The relative fit errors, parameter uncertainties and parameter reproducibilities for the Patlak, Tofts and Extended Tofts model were compared to find the most suitable model. Scan-rescan reproducibility was assessed using the interclass correlation coefficient and coefficient of variation (CV). Further, the relationship between K(trans) and AAA size was investigated. RESULTS: DCE-MRI examinations from thirty-nine patients (mean age+/-SD: 72+/-6 years; M/F: 35/4) with an mean AAA maximal diameter of 49+/-6 mm could be included for pharmacokinetic analysis. Relative fit uncertainties for K(trans) based on the Patlak model (17%) were significantly lower compared to the Tofts (37%) and Extended Tofts model (42%) (p<0.001). K(trans) scan-rescan reproducibility for the Patlak model (ICC = 0.61 and CV = 22%) was comparable with the Tofts (ICC = 0.61, CV = 23%) and Extended Tofts model (ICC = 0.76, CV = 22%). K(trans) was positively correlated with maximal AAA diameter (Spearman's rho = 0.38, p = 0.02) using the Patlak model. CONCLUSION: Using the presented imaging protocol, the Patlak model is most suited to describe DCE-MRI data of the AAA vessel wall with good K(trans) scan-rescan reproducibility.", "author" : [ { "dropping-particle" : "", "family" : "Nguyen", "given" : "V L", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Kooi", "given" : "M E", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Backes", "given" : "W H", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Hoof", "given" : "R H", "non-dropping-particle" : "van", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Saris", "given" : "A E", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Wishaupt", "given" : "M C", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Hellenthal", "given" : "F A", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Geest", "given" : "R J", "non-dropping-particle" : "van der", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Kessels", "given" : "A G", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Schurink", "given" : "G W", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Leiner", "given" : "T", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "PLoS One", "id" : "ITEM-2", "issue" : "10", "issued" : { "date-parts" : [ [ "2013" ] ] }, "note" : "Nguyen, V Lai\nKooi, M Eline\nBackes, Walter H\nvan Hoof, Raf H M\nSaris, Anne E C M\nWishaupt, Mirthe C J\nHellenthal, Femke A M V I\nvan der Geest, Rob J\nKessels, Alfons G H\nSchurink, Geert Willem H\nLeiner, Tim\neng\nComparative Study\nResearch Support, Non-U.S. Gov't\n2013/10/08 06:00\nPLoS One. 2013 Oct 2;8(10):e75173. doi: 10.1371/journal.pone.0075173. eCollection 2013.", "page" : "e75173", "title" : "Suitability of pharmacokinetic models for dynamic contrast-enhanced MRI of abdominal aortic aneurysm vessel wall: a comparison", "type" : "article-journal", "volume" : "8" }, "uris" : [ "http://www.mendeley.com/documents/?uuid=b2ea297f-fda3-40a5-867d-244bd63a6607" ] } ], "mendeley" : { "formattedCitation" : "133,134", "plainTextFormattedCitation" : "133,134", "previouslyFormattedCitation" : "133,134" }, "properties" : { }, "schema" : "https://github.com/citation-style-language/schema/raw/master/csl-citation.json" }133,134
The relationship between functional imaging findings and patient outcomes is supported by animal models of AAA.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1007/s00330-015-4010-y", "ISSN" : "14321084", "abstract" : "\u00a9 2015, European Society of Radiology. Objectives: To evaluate imaging changes occurring in a rat model of elastase-induced abdominal aortic aneurysm (AAA), with emphasis on the intraluminal thrombus (ILT) occurrence. Methods: The post-induction growth of the AAA diameter was characterized using ultrasound in 22 rats. ILT was reported on 13 rats that underwent 14 magnetic resonance imaging (MRI) 2-18 days post-surgery, and on 10 rats that underwent 18 fluoro-deoxyglucose (FDG) positron emission tomography (PET)/microcomputed tomography examinations 2-27 days post-surgery. Logistic regressions were used to establish the evolution with time of AAA length, diameter, ILT thickness, volume, stratification, MRI and FDG PET signalling properties, and histological assessment of inflammatory infiltrates. Results: All of the following significantly increased with time post-induction (p < 0.001): AAA length, AAA diameter, ILT maximal thickness, ILT volume, ILT iron content and related MRI signalling changes, quantitative uptake on FDG PET, and the magnitude of inflammatory infiltrates on histology. However, the aneurysm growth peak followed occurrence of ILT approximately 6 days after elastase infusion. Conclusion: Our model emphasizes that occurrence of ILT precedes AAA peak growth. Aneurysm growth is associated with increasing levels of iron, signalling properties changes in both MRI and FDG PET, relating to its biological activities. Key Points: \u2022 ILT occurrence in AAA is associated with increasing FDG uptake and growth. \u2022 MRI signalling changes in ILT reflect activities such as haemorrhage and RBC trapping. \u2022 Monitoring ILT activities using MRI may require no exogenous contrast agent.", "author" : [ { "dropping-particle" : "", "family" : "Nchimi", "given" : "A.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Courtois", "given" : "A.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Hachemi", "given" : "M.", "non-dropping-particle" : "El", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Touat", "given" : "Z.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Drion", "given" : "P.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Withofs", "given" : "N.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Warnock", "given" : "G.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Bahri", "given" : "M.-A.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Dogn\u00e9", "given" : "J.-M.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Cheramy-Bien", "given" : "J.-P.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Schoysman", "given" : "L.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Joskin", "given" : "J.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Michel", "given" : "J.-B.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Defraigne", "given" : "J.-O.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Plenevaux", "given" : "A.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Sakalihasan", "given" : "N.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "European Radiology", "id" : "ITEM-1", "issue" : "7", "issued" : { "date-parts" : [ [ "2016" ] ] }, "title" : "Multimodality imaging assessment of the deleterious role of the intraluminal thrombus on the growth of abdominal aortic aneurysm in a rat model", "type" : "article-journal", "volume" : "26" }, "uris" : [ "http://www.mendeley.com/documents/?uuid=bbb76d41-f6fe-34e8-a0b4-9e83f199c547" ] }, { "id" : "ITEM-2", "itemData" : { "DOI" : "10.1097/SLA.0000000000000602", "ISBN" : "1528-1140 (Electronic)\r0003-4932 (Linking)", "PMID" : "24651130", "abstract" : "OBJECTIVE: To determine whether F-fluorodeoxyglucose (F-FDG) micro-positron emission tomography (micro-PET) can predict abdominal aortic aneurysm (AAA) rupture. BACKGROUND: An infrarenal AAA model is needed to study inflammatory mechanisms that drive rupture. F-FDG PET can detect vascular inflammation in animal models and patients. METHODS: After exposing Sprague-Dawley rats to intra-aortic porcine pancreatic elastase (PPE) (12 U/mL), AAA rupture was induced by daily, subcutaneous, beta-aminopropionitrile (BAPN, 300 mg/kg, N = 24) administration. Negative control AAA animals (N = 15) underwent daily saline subcutaneous injection after PPE exposure. BAPN-exposed animals that did not rupture served as positive controls [nonruptured AAA (NRAAA) 14d, N = 9]. Rupture was witnessed using radiotelemetry. Maximum standard uptakes for F-FDG micro-PET studies were determined. Aortic wall PAI-1, uPA, and tPA concentrations were determined by western blot analyses. Interleukin (IL)-1beta, IL-6, IL-10, and MIP-2 were determined by Bio-Plex bead array. Neutrophil and macrophage populations per high-power field were quantified. Matrix metalloproteinase (MMP) activities were determined by zymography. RESULTS: When comparing ruptured AAA (RAAA) to NRAAA 14d animals, increased focal F-FDG uptakes were detected at subsequent sites of rupture (P = 0.03). PAI-1 expression was significantly less in RAAA tissue (P = 0.01), with comparable uPA and decreased tPA levels (P = 0.02). IL-1beta (P = 0.04), IL-6 (P = 0.001), IL-10 (P = 0.04), and MIP-2 (P = 0.02) expression, neutrophil (P = 0.02) and macrophage presence (P = 0.002), and MMP9 (P < 0.0001) activity were increased in RAAA tissue. CONCLUSIONS: With this AAA rupture model, increased prerupture F-FDG uptake on micro-PET imaging was associated with increased inflammation in the ruptured AAA wall. F-FDG PET imaging may be used to monitor inflammatory changes before AAA rupture.", "author" : [ { "dropping-particle" : "", "family" : "English", "given" : "S J", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Piert", "given" : "M R", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Diaz", "given" : "J A", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Gordon", "given" : "D", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Ghosh", "given" : "A", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "D'Alecy", "given" : "L G", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Whitesall", "given" : "S E", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Sharma", "given" : "A K", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "DeRoo", "given" : "E P", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Watt", "given" : "T", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Su", "given" : "G", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Henke", "given" : "P K", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Eliason", "given" : "J L", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Ailawadi", "given" : "G", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Upchurch Jr.", "given" : "G R", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Ann Surg", "id" : "ITEM-2", "issue" : "2", "issued" : { "date-parts" : [ [ "2015" ] ] }, "note" : "English, Sean J\nPiert, Morand R\nDiaz, Jose A\nGordon, David\nGhosh, Abhijit\nD'Alecy, Louis G\nWhitesall, Steven E\nSharma, Ashish K\nDeRoo, Elise P\nWatt, Tessa\nSu, Gang\nHenke, Peter K\nEliason, Jonathan L\nAilawadi, Gorav\nUpchurch, Gilbert R Jr\neng\nR01HL081629-01/HL/NHLBI NIH HHS/\nR01 HL126668/HL/NHLBI NIH HHS/\nF32 HL103065/HL/NHLBI NIH HHS/\nR01 HL081629/HL/NHLBI NIH HHS/\nF32HL103065-01/HL/NHLBI NIH HHS/\nEvaluation Studies\nResearch Support, N.I.H., Extramural\nResearch Support, Non-U.S. Gov't\n2014/03/22 06:00\nAnn Surg. 2015 Feb;261(2):395-404. doi: 10.1097/SLA.0000000000000602.", "page" : "395-404", "title" : "Increased 18F-FDG uptake is predictive of rupture in a novel rat abdominal aortic aneurysm rupture model", "type" : "article-journal", "volume" : "261" }, "uris" : [ "http://www.mendeley.com/documents/?uuid=22e57f18-d224-4a9f-aa8a-a66c86aa88ca" ] } ], "mendeley" : { "formattedCitation" : "135,136", "plainTextFormattedCitation" : "135,136", "previouslyFormattedCitation" : "135,136" }, "properties" : { }, "schema" : "https://github.com/citation-style-language/schema/raw/master/csl-citation.json" }135,136 Nevertheless, a meta-analysis ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1186/s13550-015-0153-8", "ISBN" : "2191-219X (Print)", "PMID" : "26695768", "abstract" : "PURPOSE: The purpose of this study is to give an overview of studies investigating the role of fludeoxyglucose F18 ((18)F-FDG) positron emission tomography (PET) scanning in patients with aortic aneurysms with a focus on molecular characteristics of the aneurysm wall. METHODS: MEDLINE, EMBASE, and the Cochrane database were searched for relevant articles. After inclusion and exclusion, we selected 18 relevant articles reporting on (18)F-FDG PET scanning of aortic aneurysms. RESULTS: The sample size of studies is limited, and there are no standardized imaging protocols and quantification methods. (18)F-FDG PET scanning was shown to display molecular characteristics of the aortic wall. Different studies showed contradictory findings of aortic (18)F-FDG uptake in aneurysm patients compared to controls. CONCLUSIONS: Non-invasively determining molecular characteristics of aortic wall weakening might lead to better rupture and growth prediction. This might influence the decision of the surgeon between conservative and surgical treatment of aneurysms. To date, there is conflicted evidence regarding the use of (18)F-FDG PET scanning to predict aneurysm rupture and growth. The role of (18)F-FDG PET scanning in rupture risk prediction needs to be further investigated, and standardized imaging protocols and quantification methods need to be implemented.", "author" : [ { "dropping-particle" : "", "family" : "Timur", "given" : "U T", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Herwaarden", "given" : "J A", "non-dropping-particle" : "van", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Mihajlovic", "given" : "D", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Jong", "given" : "P", "non-dropping-particle" : "De", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Mali", "given" : "W", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Moll", "given" : "F L", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "EJNMMI Res", "id" : "ITEM-1", "issue" : "1", "issued" : { "date-parts" : [ [ "2015" ] ] }, "note" : "Timur, U T\nvan Herwaarden, J A\nMihajlovic, D\nDe Jong, P\nMali, W\nMoll, F L\neng\nGermany\n2015/12/24 06:00\nEJNMMI Res. 2015 Dec;5(1):76. doi: 10.1186/s13550-015-0153-8. Epub 2015 Dec 23.", "page" : "76", "title" : "(18)F-FDG PET scanning of abdominal aortic aneurysms and correlation with molecular characteristics: a systematic review", "type" : "article-journal", "volume" : "5" }, "uris" : [ "http://www.mendeley.com/documents/?uuid=753a38eb-23f5-4a67-b97d-63c7fa3ba1e4" ] } ], "mendeley" : { "formattedCitation" : "137", "plainTextFormattedCitation" : "137", "previouslyFormattedCitation" : "137" }, "properties" : { }, "schema" : "https://github.com/citation-style-language/schema/raw/master/csl-citation.json" }137 found conflicting results when predicting AAA growth rate or rupture using functional imaging. Interestingly, 18F-FDG uptake seemed to be an indicator of AAA growth only in subgroups of patients where growth was rapid ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1007/s13139-017-0482-9", "ISBN" : "1869-3474 (Print)\r1869-3474 (Linking)", "PMID" : "29391912", "abstract" : "Purpose: Herein, we report characteristics of (18)F-fluorodeoxyglucose (FDG) uptake in abdominal aortic aneurysms (AAAs) during a long-term follow-up. In addition, we investigated the association between FDG uptake and the physician decision to perform an intervention. Methods: We performed a retrospective review of 42 patients with AAAs who underwent FDG positron emission tomography (PET)/computed tomography (CT). The size of the AAA was measured in serial CT or PET/CT images. The long-term growth rate of AAAs was calculated by linear regression of the size change. Maximal SUV of the AAA (SUVAAA) and mean SUV of the blood pool (SUVBlood) were measured in PET/CT fusion images. To assess the FDG uptake of AAAs, the target-to-background ratio (TBR) was defined as the ratio of SUVAAA to SUVBlood. We compared FDG uptake of AAAs with the long-term growth rate of AAAs and clinical data. Results: TBR was not significantly different between patients with and without significant growth (1.55 +/- 0.20 vs. 1.57 +/- 0.14; P = 0.5599). However, in patients with significant growth, TBR exhibited a significant positive correlation with the growth rate (r(2) = 0.2601, P = 0.0306). TBR also exhibited a significant difference between patients with and without intervention (P = 0.0228). Conclusion: FDG uptake of AAA is associated with long-term growth of AAAs in a specified group that exhibits growth. FDG PET/CT may only be effective in predicting the long-term growth of AAAs in specific subgroups of patients. It is also suggested that FDG PET is potentially related to the clinical conditions of AAA patients who need surgical or interventional treatment.", "author" : [ { "dropping-particle" : "", "family" : "Lee", "given" : "H", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Paeng", "given" : "J C", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Kim", "given" : "K H", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Cheon", "given" : "G J", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Lee", "given" : "D S", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Chung", "given" : "J K", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Kang", "given" : "K W", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Nucl Med Mol Imaging", "id" : "ITEM-1", "issue" : "1", "issued" : { "date-parts" : [ [ "2018" ] ] }, "note" : "Lee, Hyunjong\nPaeng, Jin Chul\nKim, Kyung Hwan\nCheon, Gi Jeong\nLee, Dong Soo\nChung, June-Key\nKang, Keon Wook\neng\nGermany\n2018/02/03 06:00\nNucl Med Mol Imaging. 2018 Feb;52(1):46-52. doi: 10.1007/s13139-017-0482-9. Epub 2017 Apr 21.", "page" : "46-52", "title" : "Correlation of FDG PET/CT Findings with Long-Term Growth and Clinical Course of Abdominal Aortic Aneurysm", "type" : "article-journal", "volume" : "52" }, "uris" : [ "http://www.mendeley.com/documents/?uuid=f61858d0-7ce8-4181-b3f3-57884d8208b0" ] } ], "mendeley" : { "formattedCitation" : "142", "plainTextFormattedCitation" : "142", "previouslyFormattedCitation" : "142" }, "properties" : { }, "schema" : "https://github.com/citation-style-language/schema/raw/master/csl-citation.json" }142. Furthermore, in studies reporting rupture as the endpoint, the site of rupture almost always spatially co-localized with increased uptake.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1053/ejvs.2002.1646 S1078588402916461 [pii]", "ISBN" : "1078-5884 (Print) 1078-5884 (Linking)", "PMID" : "12027471", "abstract" : "BACKGROUND: aneurysmal disease is associated with an inflammatory cell infiltrate and enzymatic degradation of the vessel wall. AIM OF THE STUDY: to detect increased metabolic activity in abdominal aortic aneurysms (AAA) by means of positron emission tomography (PET-imaging). STUDY DESIGN: twenty-six patients with AAA underwent PET-imaging. RESULTS: in ten patients, PET-imaging revealed increased fluoro-deoxy-glucose (18-FDG) uptake at the level of the aneurysm. Patients with positive PET-imaging had one or more of the following elements in their clinical history: history of recent non-aortic surgery (n = 4), a painful inflammatory aortic aneurysm (n = 2), moderate low back pain (n = 2), rapid (> 2;5 mm in 6 months) expansion (n = 4), discovery by PET-scan of a previously undiagnosed lung cancer (n = 3) or parotid tumour (n = 1). Five patients with a positive PET scan required urgent surgery within two to 30 days. Among the 16 patients with negative PET-imaging of their aneurysm, only one had recent non-aortic surgery, none of them required urgent surgery, only two had a rapidly expanding AAA, and in only one patient, PET-imaging revealed an unknown lung cancer. CONCLUSION: these data suggest a possible association between increased 18-FDG uptake and AAA expansion and rupture.", "author" : [ { "dropping-particle" : "", "family" : "Sakalihasan", "given" : "N", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Damme", "given" : "H", "non-dropping-particle" : "Van", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Gomez", "given" : "P", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Rigo", "given" : "P", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Lapiere", "given" : "C M", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Nusgens", "given" : "B", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Limet", "given" : "R", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Eur J Vasc Endovasc Surg", "edition" : "2002/05/25", "id" : "ITEM-1", "issue" : "5", "issued" : { "date-parts" : [ [ "2002" ] ] }, "language" : "eng", "note" : "Sakalihasan, N\nVan Damme, H\nGomez, P\nRigo, P\nLapiere, C M\nNusgens, B\nLimet, R\nEvaluation Studies\nEngland\nEuropean journal of vascular and endovascular surgery : the official journal of the European Society for Vascular Surgery\nEur J Vasc Endovasc Surg. 2002 May;23(5):431-6.", "page" : "431-436", "title" : "Positron emission tomography (PET) evaluation of abdominal aortic aneurysm (AAA)", "type" : "article-journal", "volume" : "23" }, "uris" : [ "http://www.mendeley.com/documents/?uuid=e67a9e23-2644-410e-bdc8-ecd397b8acee" ] }, { "id" : "ITEM-2", "itemData" : { "DOI" : "S1078-5884(09)00553-X [pii] 10.1016/j.ejvs.2009.10.016", "ISBN" : "1532-2165 (Electronic) 1078-5884 (Linking)", "PMID" : "19926315", "abstract" : "BACKGROUND: Functional imaging using positron emission tomography (PET) showed increased metabolic activities in the aneurysm wall prior to rupture, whereas separate studies using finite element analysis techniques found the presence of high wall stresses in aneurysms that subsequently ruptured. This case series aimed to evaluate the association between wall stress and levels of metabolic activities in aneurysms of the descending thoracic and abdominal aorta. METHODS: Five patients with aneurysms in the descending thoracic aorta or abdominal aorta were examined using positron emission tomography-computed tomography (PET-CT). Patient-specific models of the aortic aneurysms were reconstructed from CT scans, and wall tensile stresses at peak blood pressure were calculated using the finite element method. Predicted wall stresses were qualitatively compared with measured levels of 18F-fluoro-2-deoxy-glucose (18F-FDG) uptakes in the aneurysm wall. RESULTS: The distribution of wall stress in the aneurysm wall was highly non-uniform depending on the individual geometry. Predicted high wall stress regions co-localised with areas of positive 18F-FDG uptake in all five patients examined. In the two ruptured cases, the locations of rupture corresponded well with regions of elevated metabolic activity and high wall stress. CONCLUSIONS: These preliminary observations point to a potential link between high wall stress and accelerated metabolism in aortic aneurysm wall and warrant further large population-based studies.", "author" : [ { "dropping-particle" : "", "family" : "Xu", "given" : "X Y", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Borghi", "given" : "A", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Nchimi", "given" : "A", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Leung", "given" : "J", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Gomez", "given" : "P", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Cheng", "given" : "Z", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Defraigne", "given" : "J O", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Sakalihasan", "given" : "N", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Eur J Vasc Endovasc Surg", "edition" : "2009/11/21", "id" : "ITEM-2", "issue" : "3", "issued" : { "date-parts" : [ [ "2010" ] ] }, "language" : "eng", "note" : "Xu, X Y\nBorghi, A\nNchimi, A\nLeung, J\nGomez, P\nCheng, Z\nDefraigne, J O\nSakalihasan, N\nResearch Support, Non-U.S. Gov't\nEngland\nEuropean journal of vascular and endovascular surgery : the official journal of the European Society for Vascular Surgery\nEur J Vasc Endovasc Surg. 2010 Mar;39(3):295-301. Epub 2009 Nov 18.", "page" : "295-301", "title" : "High levels of 18F-FDG uptake in aortic aneurysm wall are associated with high wall stress", "type" : "article-journal", "volume" : "39" }, "uris" : [ "http://www.mendeley.com/documents/?uuid=e4de3469-ea1d-40e0-8eda-330238b5bdd7" ] } ], "mendeley" : { "formattedCitation" : "123,143", "plainTextFormattedCitation" : "123,143", "previouslyFormattedCitation" : "123,143" }, "properties" : { }, "schema" : "https://github.com/citation-style-language/schema/raw/master/csl-citation.json" }123,143
[H2] Computational analyses
Three-dimensional anatomy provided by imaging techniques (CT, MRI and ultrasonography in decreasing order of relevance) may offer an alternative assessment of the risk of rupture via Finite Element Analysis (FEA) (FIG. 7). This approach assumes that in the AAA, the forces towards rupture oppose to the structural stability (resistance). The force is a multidirectional vector that applies on a surface both directly (Law of Laplace) and by shearing. FEA estimates the pressure [Newton per square meter (N/m) or Pascal (Pa)] acting on the aortic wall and promoting dilatation and rupture risk based on computational models obtained from 3D images.
A meta-analysis compiled 9 studies (348 patients) that retrospectively evaluated whether FEA differentiated between intact (or asymptomatic) and ruptured (or symptomatic) aneurysms.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1002/bjs.9578", "ISBN" : "1365-2168 (Electronic)\r0007-1323 (Linking)", "PMID" : "25131598", "abstract" : "BACKGROUND: Abdominal aortic aneurysm (AAA) is an important cause of sudden death; however, there are currently incomplete means to predict the risk of AAA rupture. AAA peak wall stress (PWS) can be estimated using finite element analysis (FEA) methods from computed tomography (CT) scans. The question is whether AAA PWS can predict AAA rupture. The aim of this systematic review was to compare PWS in patients with ruptured and intact AAA. METHODS: The MEDLINE database was searched on 25 May 2013. Case-control studies assessing PWS in asymptomatic intact, and acutely symptomatic or ruptured AAA from CT scans using FEA were included. Data were extracted independently. A random-effects model was used to calculate standard mean differences (SMDs) for PWS measurements. RESULTS: Nine studies assessing 348 individuals were identified and used in the meta-analysis. Results from 204 asymptomatic intact and 144 symptomatic or ruptured AAAs showed that PWS was significantly greater in the symptomatic/ ruptured AAAs compared with the asymptomatic intact AAAs (SMD 0.95, 95 per cent confidence interval 0.71 to 1.18; P < 0.001). The findings remained significant after adjustment for mean systolic blood pressure, standardized at 120 mmHg (SMD 0.68, 0.39 to 0.96; P < 0.001). Minimal heterogeneity between studies was noted (I(2) = 0 per cent). CONCLUSION: This study suggests that PWS is greater in symptomatic or ruptured AAA than in asymptomatic intact AAA.", "author" : [ { "dropping-particle" : "", "family" : "Khosla", "given" : "S", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Morris", "given" : "D R", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "V", "family" : "Moxon", "given" : "J", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Walker", "given" : "P J", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Gasser", "given" : "T C", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Golledge", "given" : "J", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Br J Surg", "id" : "ITEM-1", "issue" : "11", "issued" : { "date-parts" : [ [ "2014" ] ] }, "note" : "Khosla, S\nMorris, D R\nMoxon, J V\nWalker, P J\nGasser, T C\nGolledge, J\neng\nComparative Study\nMeta-Analysis\nReview\nEngland\n2014/08/19 06:00\nBr J Surg. 2014 Oct;101(11):1350-7; discussion 1357. doi: 10.1002/bjs.9578. Epub 2014 Aug 11.", "page" : "1350-7; discussion 1357", "title" : "Meta-analysis of peak wall stress in ruptured, symptomatic and intact abdominal aortic aneurysms", "type" : "article-journal", "volume" : "101" }, "uris" : [ "http://www.mendeley.com/documents/?uuid=d9a160b9-8447-4768-b1d0-7e760e0134ba" ] } ], "mendeley" : { "formattedCitation" : "144", "plainTextFormattedCitation" : "144", "previouslyFormattedCitation" : "144" }, "properties" : { }, "schema" : "https://github.com/citation-style-language/schema/raw/master/csl-citation.json" }144 The maximal wall stress was significantly higher in ruptured or symptomatic aneurysms in 7 of the 9 studies.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1007/s10439-008-9490-3", "ISBN" : "1573-9686 (Electronic)\r0090-6964 (Linking)", "PMID" : "18398680", "abstract" : "The local dilation of the infrarenal abdominal aorta, termed an abdominal aortic aneurysm (AAA), is often times asymptomatic and may eventually result in rupture-an event associated with a significant mortality rate. The estimation of in-vivo stresses within AAAs has been proposed as a useful tool to predict the likelihood of rupture. For the current work, a previously-derived anisotropic relation for the AAA wall was implemented into patient-specific finite element simulations of AAA. There were 35 AAAs simulated in the current work which were broken up into three groups: elective repairs (n = 21), non-ruptured repairs (n = 5), and ruptured repairs (n = 9). Peak stresses and strains were compared using the anisotropic and isotropic constitutive relations. There were significant increases in peak stress when using the anisotropic relationship (p < 0.001), even in the absence of the ILT (p = 0.014). Ruptured AAAs resulted in elevated peak stresses as compared to non-ruptured AAAs when using both the isotropic and anisotropic simulations, however these comparisons did not reach significance (p(ani) = 0.55, p(iso) = 0.73). While neither the isotropic or anisotropic simulations were able to significantly discriminate ruptured vs. non-ruptured AAAs, the lower p-value when using the anisotropic model suggests including it into patient-specific AAAs may help better identify AAAs at high risk.", "author" : [ { "dropping-particle" : "", "family" : "Geest", "given" : "J P", "non-dropping-particle" : "Vande", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Schmidt", "given" : "D E", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Sacks", "given" : "M S", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Vorp", "given" : "D A", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Ann Biomed Eng", "id" : "ITEM-1", "issue" : "6", "issued" : { "date-parts" : [ [ "2008" ] ] }, "note" : "Vande Geest, Jonathan P\nSchmidt, David E\nSacks, Michael S\nVorp, David A\neng\nR01 HL060670/HL/NHLBI NIH HHS/\nR01 HL060670-07/HL/NHLBI NIH HHS/\nR01-HL-60670/HL/NHLBI NIH HHS/\nResearch Support, N.I.H., Extramural\nResearch Support, Non-U.S. Gov't\n2008/04/10 09:00\nAnn Biomed Eng. 2008 Jun;36(6):921-32. doi: 10.1007/s10439-008-9490-3. Epub 2008 Apr 9.", "page" : "921-932", "title" : "The effects of anisotropy on the stress analyses of patient-specific abdominal aortic aneurysms", "type" : "article-journal", "volume" : "36" }, "uris" : [ "http://www.mendeley.com/documents/?uuid=be27412a-2c2e-4d43-b41a-b21b4f4dff24" ] }, { "id" : "ITEM-2", "itemData" : { "DOI" : "10.1196/annals.1383.046", "ISBN" : "0077-8923 (Print)\r0077-8923 (Linking)", "PMID" : "17182918", "abstract" : "Abdominal aortic aneurysms (AAAs) can typically remain stable until the strength of the aortic wall is unable to withstand the forces acting on it as a result of the luminal blood pressure, resulting in AAA rupture. The clinical treatment of AAA patients presents a dilemma for the surgeon: surgery should only be recommended when the risk of rupture of the AAA outweighs the risks associated with the interventional procedure. Since AAA rupture occurs when the stress acting on the wall exceeds its strength, the assessment of AAA rupture should include estimates of both wall stress and wall strength distributions. The present work details a method for noninvasively assessing the rupture potential of AAAs using patient-specific estimations the rupture potential index (RPI) of the AAA, calculated as the ratio of locally acting wall stress to strength. The RPI was calculated for thirteen AAAs, which were broken up into ruptured (n = 8 and nonruptured (n = 5) groups. Differences in peak wall stress, minimum strength and maximum RPI were compared across groups. There were no statistical differences in the maximum transverse diameters (6.8 +/- 0.3 cm vs. 6.1 +/- 0.5 cm, p = 0.26) or peak wall stress (46.0 +/- 4.3 vs. 49.9 +/- 4.0 N/cm(2), p = 0.62) between groups. There was a significant decrease in minimum wall strength for ruptured AAA (81.2 +/- 3.9 and 108.3 +/- 10.2 N/cm(2), p = 0.045). While the differences in RPI values (ruptured = 0.48 +/- 0.05 vs. nonruptured = 0.36 +/- 0.03, respectively; p = 0.10) did not reach statistical significance, the p-value for the peak RPI comparison was lower than that for both the maximum diameter (p = 0.26) and peak wall stress (p = 0.62) comparisons. This result suggests that the peak RPI may be better able to identify those AAAs at high risk of rupture than maximum diameter or peak wall stress alone. The clinical relevance of this method for rupture assessment has yet to be validated, however, its success could aid clinicians in decision making and AAA patient management.", "author" : [ { "dropping-particle" : "", "family" : "Geest", "given" : "J P", "non-dropping-particle" : "Vande", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Martino", "given" : "E S", "non-dropping-particle" : "Di", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Bohra", "given" : "A", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Makaroun", "given" : "M S", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Vorp", "given" : "D A", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Ann N Y Acad Sci", "id" : "ITEM-2", "issued" : { "date-parts" : [ [ "2006" ] ] }, "note" : "Vande Geest, Jonathan P\nDi Martino, Elena S\nBohra, Ajay\nMakaroun, Michel S\nVorp, David A\neng\nR01 HL 079313/HL/NHLBI NIH HHS/\nR01 HL60670/HL/NHLBI NIH HHS/\nResearch Support, N.I.H., Extramural\n2006/12/22 09:00\nAnn N Y Acad Sci. 2006 Nov;1085:11-21. doi: 10.1196/annals.1383.046.", "page" : "11-21", "title" : "A biomechanics-based rupture potential index for abdominal aortic aneurysm risk assessment: demonstrative application", "type" : "article-journal", "volume" : "1085" }, "uris" : [ "http://www.mendeley.com/documents/?uuid=bf529eb3-6717-44c4-8fd8-cda782b43f8d" ] } ], "mendeley" : { "formattedCitation" : "145,146", "plainTextFormattedCitation" : "145,146", "previouslyFormattedCitation" : "145,146" }, "properties" : { }, "schema" : "https://github.com/citation-style-language/schema/raw/master/csl-citation.json" }145,146 In addition, wall stress estimates better discriminated patient groups than the maximal aortic diameter. There have also been preliminary studies on the association between wall stress and AAA growth rate.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1016/j.ejvs.2009.12.021", "ISBN" : "1532-2165 (Electronic)\r1078-5884 (Linking)", "PMID" : "20060752", "abstract" : "OBJECTIVES: This study investigated the relation between abdominal aortic aneurysm (AAA) wall stress, AAA growth rate and biomarker concentrations. With increasing wall stress, more damage may be caused to the AAA wall, possibly leading to progression of the aneurysm and reflection in up- or downregulation of specific circulating biomarkers. Levels of matrix metalloproteinase-9, tissue inhibitor of matrix metalloproteinase-1, C-reactive protein and alpha 1-antitrypsin were therefore evaluated. METHODS: Thirty-seven patients (maximum AAA diameter 41-55mm) with two, three or four consecutive computed tomography angiography (CTA) scans were prospectively included. Diameter growth rate in mm/year was determined between each pair of two sequential CTA scans. AAA wall stress was computed by finite element analysis, based on the first of the two sequential CTA scans only (n=69 pairs). Biomarker information was determined in 46 measurements in 18 patients. The relation between AAA diameter and wall stress was determined and the AAA's were divided into three equally sized groups (relative low, medium and high stress). Growth rate and biomarker concentrations were compared between these groups. Additionally, correlation coefficients were computed between absolute wall stress, AAA growth and biomarker concentrations. RESULTS: A relative low AAA wall stress was associated with a lower aneurysm growth rate. Growth rate was also positively related to MMP-9 plasma concentration (r=0.32). The average MMP-9 and CRP concentrations increased with increasing degrees of relative wall stress, although the absolute and relative wall stress did not correlate with any of the biomarkers. CONCLUSION: Although lower relative wall stress was associated to a lower AAA growth rate, no relation was found between biomarker concentrations and wall stress. Future research may focus on more and extensive biomarker measurements in relation to AAA wall stress.", "author" : [ { "dropping-particle" : "", "family" : "Speelman", "given" : "L", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Hellenthal", "given" : "F A", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Pulinx", "given" : "B", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Bosboom", "given" : "E M", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Breeuwer", "given" : "M", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Sambeek", "given" : "M R", "non-dropping-particle" : "van", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Vosse", "given" : "F N", "non-dropping-particle" : "van de", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Jacobs", "given" : "M J", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Wodzig", "given" : "W K", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Schurink", "given" : "G W", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Eur J Vasc Endovasc Surg", "id" : "ITEM-1", "issue" : "4", "issued" : { "date-parts" : [ [ "2010" ] ] }, "note" : "Speelman, L\nHellenthal, F A\nPulinx, B\nBosboom, E M H\nBreeuwer, M\nvan Sambeek, M R\nvan de Vosse, F N\nJacobs, M J\nWodzig, W K W H\nSchurink, G W H\neng\nEngland\n2010/01/12 06:00\nEur J Vasc Endovasc Surg. 2010 Apr;39(4):410-6. doi: 10.1016/j.ejvs.2009.12.021. Epub 2010 Jan 8.", "page" : "410-416", "title" : "The influence of wall stress on AAA growth and biomarkers", "type" : "article-journal", "volume" : "39" }, "uris" : [ "http://www.mendeley.com/documents/?uuid=2b0dfaae-0fe7-4961-9ffe-1c36b959d3cd" ] } ], "mendeley" : { "formattedCitation" : "147", "plainTextFormattedCitation" : "147", "previouslyFormattedCitation" : "147" }, "properties" : { }, "schema" : "https://github.com/citation-style-language/schema/raw/master/csl-citation.json" }147 ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "CIRCULATIONAHA.110.939819 [pii] 10.1161/CIRCULATIONAHA.110.939819", "ISBN" : "1524-4539 (Electronic) 0009-7322 (Linking)", "PMID" : "20956212", "abstract" : "BACKGROUND: Aneurysm expansion rate is an important indicator of the potential risk of abdominal aortic aneurysm (AAA) rupture. Stress within the AAA wall is also thought to be a trigger for its rupture. However, the association between aneurysm wall stresses and expansion of AAA is unclear. METHODS AND RESULTS: Forty-four patients with AAAs were included in this longitudinal follow-up study. They were assessed by serial abdominal ultrasonography and computed tomography scans if a critical size was reached or a rapid expansion occurred. Patient-specific 3-dimensional AAA geometries were reconstructed from the follow-up computed tomography images. Structural analysis was performed to calculate the wall stresses of the AAA models at both baseline and final visit. A nonlinear large-strain finite element method was used to compute the wall-stress distribution. The relationship between wall stresses and expansion rate was investigated. Slowly and rapidly expanding aneurysms had comparable baseline maximum diameters (median, 4.35 cm [interquartile range, 4.12 to 5.0 cm] versus 4.6 cm [interquartile range, 4.2 to 5.0 cm]; P=0.32). Rapidly expanding AAAs had significantly higher shoulder stresses than slowly expanding AAAs (median, 300 kPa [interquartile range, 280 to 320 kPa] versus 225 kPa [interquartile range, 211 to 249 kPa]; P=0.0001). A good correlation between shoulder stress at baseline and expansion rate was found (r=0.71; P=0.0001). CONCLUSION: A higher shoulder stress was found to have an association with a rapidly expanding AAA. Therefore, it may be useful for estimating the expansion of AAAs and improve risk stratification of patients with AAAs.", "author" : [ { "dropping-particle" : "", "family" : "Li", "given" : "Z Y", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Sadat", "given" : "U", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "J", "given" : "U King-Im", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Tang", "given" : "T Y", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Bowden", "given" : "D J", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Hayes", "given" : "P D", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Gillard", "given" : "J H", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Circulation", "edition" : "2010/10/20", "id" : "ITEM-1", "issue" : "18", "issued" : { "date-parts" : [ [ "2010" ] ] }, "language" : "eng", "note" : "Li, Zhi-Yong\nSadat, Umar\nU-King-Im, Jean\nTang, Tjun Y\nBowden, David J\nHayes, Paul D\nGillard, Jonathan H\nUnited States\nCirculation\nCirculation. 2010 Nov 2;122(18):1815-22. Epub 2010 Oct 18.", "page" : "1815-1822", "title" : "Association between aneurysm shoulder stress and abdominal aortic aneurysm expansion: a longitudinal follow-up study", "type" : "article-journal", "volume" : "122" }, "uris" : [ "http://www.mendeley.com/documents/?uuid=a7b50e7d-e5a8-44bc-91a4-b92147642e34" ] } ], "mendeley" : { "formattedCitation" : "148", "plainTextFormattedCitation" : "148", "previouslyFormattedCitation" : "148" }, "properties" : { }, "schema" : "https://github.com/citation-style-language/schema/raw/master/csl-citation.json" }148 Once obtained, wall stress can be correlated to the wall resistance obtained from in vitro biomechanical testing of aortic tissues, to provide a biomechanical relative rupture risk index, which discriminates better than wall stress, symptomatic versus asymptomatic aneurysms, but there is no prospective validation of the relative rupture risk index.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1177/1526602815612196", "ISBN" : "1545-1550 (Electronic)\r1526-6028 (Linking)", "PMID" : "26496955", "abstract" : "PURPOSE: To associate regions of highest local rupture risk from finite element analysis (FEA) to subsequent rupture sites in abdominal aortic aneurysms (AAA). METHODS: This retrospective multicenter study analyzed computed tomography angiography (CTA) data from 13 asymptomatic AAA patients (mean age 76 years; 8 men) experiencing rupture at a later point in time between 2005 and 2011. All patients had CTA scans before and during the rupture event. FEA was performed to calculate peak wall stress (PWS), peak wall rupture risk (PWRR), rupture risk equivalent diameters (RRED), and the intraluminal thrombus volume (ILTV). PWS and PWRR locations in the prerupture state were compared with subsequent CTA rupture findings. Visible contrast extravasation was considered a definite (n=5) rupture sign, while a periaortic hematoma was an indefinite (n=8) sign. A statistical comparison was performed between the 13-patient asymptomatic AAA group before and during rupture and a 23-patient diameter-matched asymptomatic AAA control group that underwent elective surgery. RESULTS: The asymptomatic AAAs before rupture showed significantly higher PWRR and RRED values compared to the matched asymptomatic AAA control group (median values 0.74 vs 0.52 and 77 vs 59 mm, respectively; p<0.0001 for both). No statistical differences could be found for PWS and ILTV. Ruptured AAAs showed the highest maximum diameters, PWRR, and RRED values. In 7 of the ruptured AAAs (2 definite and 5 indefinite rupture signs), CTA rupture sites correlated with prerupture PWRR locations. CONCLUSION: The location of the PWRR in unruptured AAAs predicted future rupture sites in several cases. Asymptomatic AAA patients with high PWRR and RRED values have an increased rupture risk.", "author" : [ { "dropping-particle" : "", "family" : "Erhart", "given" : "P", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Roy", "given" : "J", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Vries", "given" : "J P", "non-dropping-particle" : "de", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Liljeqvist", "given" : "M L", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Grond-Ginsbach", "given" : "C", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Hyhlik-Durr", "given" : "A", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Bockler", "given" : "D", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "J Endovasc Ther", "id" : "ITEM-1", "issue" : "1", "issued" : { "date-parts" : [ [ "2016" ] ] }, "note" : "Erhart, Philipp\nRoy, Joy\nde Vries, Jean-Paul P M\nLiljeqvist, Moritz Lindquist\nGrond-Ginsbach, Caspar\nHyhlik-Durr, Alexander\nBockler, Dittmar\neng\nMulticenter Study\nResearch Support, Non-U.S. Gov't\n2015/10/27 06:00\nJ Endovasc Ther. 2016 Feb;23(1):115-20. doi: 10.1177/1526602815612196. Epub 2015 Oct 23.", "page" : "115-120", "title" : "Prediction of Rupture Sites in Abdominal Aortic Aneurysms After Finite Element Analysis", "type" : "article-journal", "volume" : "23" }, "uris" : [ "http://www.mendeley.com/documents/?uuid=7e485029-366a-42e4-ab8f-abc8c1d923f8" ] } ], "mendeley" : { "formattedCitation" : "149", "plainTextFormattedCitation" : "149", "previouslyFormattedCitation" : "149" }, "properties" : { }, "schema" : "https://github.com/citation-style-language/schema/raw/master/csl-citation.json" }149
Despite their ongoing refinements, the widespread use of computational analyses in AAAs is limited by availability of technical resources and concerns such as case-specific non-valid assumptions (e.g., standardized inflow conditions, aortic wall rigidity and homogeneity of the biomechanical properties of the AAA wall components).ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1016/j.jvs.2017.05.086", "ISBN" : "1097-6809 (Electronic)\r0741-5214 (Linking)", "PMID" : "28899569", "abstract" : "OBJECTIVE: Parameters other than maximum diameter that predict rupture of abdominal aortic aneurysms (AAAs) may be helpful for risk-benefit analysis in individual patients. The aim of this study was to characterize the biomechanical-structural characteristics associated with AAA walls to better identify the related mechanistic variables required for an accurate prediction of rupture risk. METHODS: Anterior AAA wall (n = 40) and intraluminal thrombus (ILT; n = 114) samples were acquired from 18 patients undergoing open surgical repair. Biomechanical characterization was performed using controlled circumferential stretching tests combined with a speckle-strain tracking technique to quantify the spatial heterogeneity in deformation and localized strains in the AAA walls containing calcification. After mechanical testing, the accompanying microstructural characteristics of the AAA wall and ILT types were examined using electron microscopy. RESULTS: No significant correlation was found between the AAA diameter and the wall mechanical properties in terms of Cauchy stress (rs = -0.139; P = .596) or stiffness (rs = -0.451; P = .069). Quantification of significant localized peak strains, which were concentrated in the tissue regions surrounding calcification, reveals that peak strains increased by a mean of 174% as a result of calcification and corresponding peak stresses by 18.2%. Four ILT types characteristic of diverse stages in the evolving tissue microstructure were directly associated with distinct mechanical stiffness properties of the ILT and underlying AAA wall. ILT types were independent of geometric factors, including ILT volume and AAA diameter measures (ILT stiffness and AAA diameter [rs = -0.511; P = .074]; ILT stiffness and ILT volume [rs = -0.245; P = .467]). CONCLUSIONS: AAA wall stiffness properties are controlled by the load-bearing capacity of the noncalcified tissue portion, and low stiffness properties represent a highly degraded vulnerable wall. The presence of calcification that is contiguous with the inner wall causes severe tissue overstretching in surrounding tissue areas. The results highlight the use of additional biomechanical measures, detailing the biomechanical-structural characteristics of AAA tissue, that may be a helpful adjunct to improve the accuracy of rupture prediction.", "author" : [ { "dropping-particle" : "", "family" : "Barrett", "given" : "H E", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Cunnane", "given" : "E M", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Hidayat", "given" : "H", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "O'Brien", "given" : "J M", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Moloney", "given" : "M A", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Kavanagh", "given" : "E G", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Walsh", "given" : "M T", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "J Vasc Surg", "id" : "ITEM-1", "issued" : { "date-parts" : [ [ "2017" ] ] }, "note" : "Barrett, Hilary E\nCunnane, Eoghan M\nHidayat, Hena\nO'Brien, Julie M\nMoloney, Michael A\nKavanagh, Eamon G\nWalsh, Michael T\neng\n2017/09/14 06:00\nJ Vasc Surg. 2017 Sep 9. pii: S0741-5214(17)31598-7. doi: 10.1016/j.jvs.2017.05.086.", "title" : "On the influence of wall calcification and intraluminal thrombus on prediction of abdominal aortic aneurysm rupture", "type" : "article-journal" }, "uris" : [ "http://www.mendeley.com/documents/?uuid=7b282e79-8d59-4762-b995-c332d0474f13" ] } ], "mendeley" : { "formattedCitation" : "150", "plainTextFormattedCitation" : "150", "previouslyFormattedCitation" : "150" }, "properties" : { }, "schema" : "https://github.com/citation-style-language/schema/raw/master/csl-citation.json" }150 Therefore, the role of computational analyses in predicting the rupture site in AAA is debatable.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1016/j.jbiomech.2017.09.041", "ISBN" : "1873-2380 (Electronic)\r0021-9290 (Linking)", "PMID" : "29102265", "abstract" : "OBJECTIVE: To investigate whether peak wall tension in abdominal aortic aneurysm occurs at the site of rupture to test for a causative relationship. METHODS: Four ruptured and nine unruptured AAA were harvested whole from cadavers, followed by regional measurements of wall thickness, elastic parameters and failure tension. Finite element models were developed with subject-specific load-free AAA morphology and heterogeneous properties interpolated using a geodesic distance weighted approach from the measurements. The wall tension under uniform pressure and tension to failure tension ratio as an index of susceptibility to rupture were computed. As a secondary aim, the peak wall tension using this heterogeneous model approach was compared to the traditional homogeneous model approach in order to evaluate the reliability of the latter. RESULTS: The average peak wall tension in the ruptured group was 43% higher than in the unruptured group without statistical significance even though it was 54% larger in diameter. The site of peak wall tension was in the vicinity of the site of rupture in two ruptured AAA. The peak tension did not breach failure tension at the rupture site in any of the AAA. The traditional population-wide homogeneous model approach overestimated peak wall tension by just 3% compared to the subject-specific heterogeneous model approach. CONCLUSION: We failed to find adequate evidence of a causative relationship between peak wall tension and AAA rupture. The findings are not conclusive owing to study limitations such as ignoring intraluminal thrombus, sparse distribution of specimens procured and small study population.", "author" : [ { "dropping-particle" : "", "family" : "Chung", "given" : "T K", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Silva", "given" : "E S", "non-dropping-particle" : "da", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Raghavan", "given" : "S M L", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "J Biomech", "id" : "ITEM-1", "issued" : { "date-parts" : [ [ "2017" ] ] }, "note" : "Chung, Timothy K\nda Silva, Erasmo S\nRaghavan, Suresh M L\neng\n2017/11/06 06:00\nJ Biomech. 2017 Nov 7;64:164-171. doi: 10.1016/j.jbiomech.2017.09.041. Epub 2017 Oct 6.", "page" : "164-171", "title" : "Does elevated wall tension cause aortic aneurysm rupture? Investigation using a subject-specific heterogeneous model", "type" : "article-journal", "volume" : "64" }, "uris" : [ "http://www.mendeley.com/documents/?uuid=45db0afc-040e-42ab-9c7e-2783f78e04ad" ] } ], "mendeley" : { "formattedCitation" : "151", "plainTextFormattedCitation" : "151", "previouslyFormattedCitation" : "151" }, "properties" : { }, "schema" : "https://github.com/citation-style-language/schema/raw/master/csl-citation.json" }151 Several investigations have reported a spatial colocalization of the maximal wall stress and the rupture site,ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "S1078-5884(09)00553-X [pii] 10.1016/j.ejvs.2009.10.016", "ISBN" : "1532-2165 (Electronic) 1078-5884 (Linking)", "PMID" : "19926315", "abstract" : "BACKGROUND: Functional imaging using positron emission tomography (PET) showed increased metabolic activities in the aneurysm wall prior to rupture, whereas separate studies using finite element analysis techniques found the presence of high wall stresses in aneurysms that subsequently ruptured. This case series aimed to evaluate the association between wall stress and levels of metabolic activities in aneurysms of the descending thoracic and abdominal aorta. METHODS: Five patients with aneurysms in the descending thoracic aorta or abdominal aorta were examined using positron emission tomography-computed tomography (PET-CT). Patient-specific models of the aortic aneurysms were reconstructed from CT scans, and wall tensile stresses at peak blood pressure were calculated using the finite element method. Predicted wall stresses were qualitatively compared with measured levels of 18F-fluoro-2-deoxy-glucose (18F-FDG) uptakes in the aneurysm wall. RESULTS: The distribution of wall stress in the aneurysm wall was highly non-uniform depending on the individual geometry. Predicted high wall stress regions co-localised with areas of positive 18F-FDG uptake in all five patients examined. In the two ruptured cases, the locations of rupture corresponded well with regions of elevated metabolic activity and high wall stress. CONCLUSIONS: These preliminary observations point to a potential link between high wall stress and accelerated metabolism in aortic aneurysm wall and warrant further large population-based studies.", "author" : [ { "dropping-particle" : "", "family" : "Xu", "given" : "X Y", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Borghi", "given" : "A", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Nchimi", "given" : "A", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Leung", "given" : "J", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Gomez", "given" : "P", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Cheng", "given" : "Z", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Defraigne", "given" : "J O", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Sakalihasan", "given" : "N", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Eur J Vasc Endovasc Surg", "edition" : "2009/11/21", "id" : "ITEM-1", "issue" : "3", "issued" : { "date-parts" : [ [ "2010" ] ] }, "language" : "eng", "note" : "Xu, X Y\nBorghi, A\nNchimi, A\nLeung, J\nGomez, P\nCheng, Z\nDefraigne, J O\nSakalihasan, N\nResearch Support, Non-U.S. Gov't\nEngland\nEuropean journal of vascular and endovascular surgery : the official journal of the European Society for Vascular Surgery\nEur J Vasc Endovasc Surg. 2010 Mar;39(3):295-301. Epub 2009 Nov 18.", "page" : "295-301", "title" : "High levels of 18F-FDG uptake in aortic aneurysm wall are associated with high wall stress", "type" : "article-journal", "volume" : "39" }, "uris" : [ "http://www.mendeley.com/documents/?uuid=e4de3469-ea1d-40e0-8eda-330238b5bdd7" ] }, { "id" : "ITEM-2", "itemData" : { "DOI" : "10.1177/1526602815612196", "ISBN" : "1545-1550 (Electronic)\r1526-6028 (Linking)", "PMID" : "26496955", "abstract" : "PURPOSE: To associate regions of highest local rupture risk from finite element analysis (FEA) to subsequent rupture sites in abdominal aortic aneurysms (AAA). METHODS: This retrospective multicenter study analyzed computed tomography angiography (CTA) data from 13 asymptomatic AAA patients (mean age 76 years; 8 men) experiencing rupture at a later point in time between 2005 and 2011. All patients had CTA scans before and during the rupture event. FEA was performed to calculate peak wall stress (PWS), peak wall rupture risk (PWRR), rupture risk equivalent diameters (RRED), and the intraluminal thrombus volume (ILTV). PWS and PWRR locations in the prerupture state were compared with subsequent CTA rupture findings. Visible contrast extravasation was considered a definite (n=5) rupture sign, while a periaortic hematoma was an indefinite (n=8) sign. A statistical comparison was performed between the 13-patient asymptomatic AAA group before and during rupture and a 23-patient diameter-matched asymptomatic AAA control group that underwent elective surgery. RESULTS: The asymptomatic AAAs before rupture showed significantly higher PWRR and RRED values compared to the matched asymptomatic AAA control group (median values 0.74 vs 0.52 and 77 vs 59 mm, respectively; p<0.0001 for both). No statistical differences could be found for PWS and ILTV. Ruptured AAAs showed the highest maximum diameters, PWRR, and RRED values. In 7 of the ruptured AAAs (2 definite and 5 indefinite rupture signs), CTA rupture sites correlated with prerupture PWRR locations. CONCLUSION: The location of the PWRR in unruptured AAAs predicted future rupture sites in several cases. Asymptomatic AAA patients with high PWRR and RRED values have an increased rupture risk.", "author" : [ { "dropping-particle" : "", "family" : "Erhart", "given" : "P", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Roy", "given" : "J", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Vries", "given" : "J P", "non-dropping-particle" : "de", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Liljeqvist", "given" : "M L", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Grond-Ginsbach", "given" : "C", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Hyhlik-Durr", "given" : "A", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Bockler", "given" : "D", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "J Endovasc Ther", "id" : "ITEM-2", "issue" : "1", "issued" : { "date-parts" : [ [ "2016" ] ] }, "note" : "Erhart, Philipp\nRoy, Joy\nde Vries, Jean-Paul P M\nLiljeqvist, Moritz Lindquist\nGrond-Ginsbach, Caspar\nHyhlik-Durr, Alexander\nBockler, Dittmar\neng\nMulticenter Study\nResearch Support, Non-U.S. Gov't\n2015/10/27 06:00\nJ Endovasc Ther. 2016 Feb;23(1):115-20. doi: 10.1177/1526602815612196. Epub 2015 Oct 23.", "page" : "115-120", "title" : "Prediction of Rupture Sites in Abdominal Aortic Aneurysms After Finite Element Analysis", "type" : "article-journal", "volume" : "23" }, "uris" : [ "http://www.mendeley.com/documents/?uuid=7e485029-366a-42e4-ab8f-abc8c1d923f8" ] } ], "mendeley" : { "formattedCitation" : "143,149", "plainTextFormattedCitation" : "143,149", "previouslyFormattedCitation" : "143,149" }, "properties" : { }, "schema" : "https://github.com/citation-style-language/schema/raw/master/csl-citation.json" }143,149 and areas under high wall stress exhibited histopathological features of aneurysmal wall weakening, compared to areas at low wall stress on the same aneurysm.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1583/14-4695.1", "ISBN" : "1545-1550 (Electronic) 1526-6028 (Linking)", "PMID" : "25101586", "abstract" : "PURPOSE: To evaluate a finite element analysis (FEA) model as a predictive tool for abdominal aortic aneurysm (AAA) rupture risk assessment. METHODS: FEA of asymptomatic infrarenal AAAs in 15 men (mean age 72 years) was performed preoperatively using semiautomatic finite element analysis software (A4clinics) to calculate peak wall stress (PWS) and regions of highest and lowest rupture risk index (RRI). The areas of high and low RRI identified on the preoperative FEA were sampled during open surgery; aortic wall specimens were prepared for histological analysis. A semiquantitative score compared the histological findings from high and low rupture risk samples. RESULTS: Significant correlation was found between histological AAA wall integrity and RRI in individual patients. AAA wall regions with highest RRI showed advanced histological disintegrity compared to regions with lower RRI within the same AAA: mean smooth muscle cells: 0.43 vs. 1.21, respectively (p=0.031); elastic fibers: 0.57 vs. 1.29, respectively (p=0.008); cholesterol plaque: 2.60 vs. 2.20, respectively (p=0.034); and calcified plaque: 2.27 vs. 1.40, respectively (p=0.017). The amount of calcified plaque was significantly correlated with PWS (r=0.528, p=0.043) by univariate regression analysis. However, there was no correlation between PWS or RRI and the histological findings between patients. CONCLUSION: These preliminary results show that high rupture risk regions estimated by FEA contain increased histopathological degeneration compared to low rupture risk samples within the same AAA. Until now, the role of FEA in predicting individual AAA rupture risk has not been established as a validated diagnostic tool. However, these data provide promising results for FEA model verification.", "author" : [ { "dropping-particle" : "", "family" : "Erhart", "given" : "P", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Grond-Ginsbach", "given" : "C", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Hakimi", "given" : "M", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Lasitschka", "given" : "F", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Dihlmann", "given" : "S", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Bockler", "given" : "D", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Hyhlik-Durr", "given" : "A", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "J Endovasc Ther", "id" : "ITEM-1", "issue" : "4", "issued" : { "date-parts" : [ [ "2014" ] ] }, "note" : "Erhart, Philipp\nGrond-Ginsbach, Caspar\nHakimi, Maani\nLasitschka, Felix\nDihlmann, Susanne\nBockler, Dittmar\nHyhlik-Durr, Alexander\neng\n2014/08/08 06:00\nJ Endovasc Ther. 2014 Aug;21(4):556-64. doi: 10.1583/14-4695.1.", "page" : "556-564", "title" : "Finite element analysis of abdominal aortic aneurysms: predicted rupture risk correlates with aortic wall histology in individual patients", "type" : "article-journal", "volume" : "21" }, "uris" : [ "http://www.mendeley.com/documents/?uuid=0bfa2897-4d08-4430-8e52-690d2c908fe1" ] }, { "id" : "ITEM-2", "itemData" : { "DOI" : "10.12945/j.aorta.2015.14.069", "ISBN" : "2325-4637 (Print)\r2325-4637 (Linking)", "PMID" : "27175366", "abstract" : "BACKGROUND: Since aortic diameter is the most -significant risk factor for rupture, we sought to identify stress-dependent changes in gene expression to illuminate novel molecular processes in aneurysm rupture. MATERIALS AND METHODS: We constructed finite element maps of abdominal computerized tomography scans (CTs) of seven abdominal aortic aneurysm (AAA) patients to map wall stress. Paired biopsies from high- and low-stress areas were collected at surgery using vascular landmarks as coordinates. Differential gene expression was evaluated by Illumina Array analysis, using the whole genome DNA-mediated, annealing, selection, extension, and ligation (DASL) gene chip (n = 3 paired samples). RESULTS: The sole significant candidate from this analysis, Lamin A/C, was validated at the protein level, using western blotting. Lamin A/C expression in the inferior mesenteric vein (IMV) of AAA patients was compared to a control group and in aortic smooth muscle cells in culture in response to physiological pulsatile stretch. -Areas of high wall stress (n = 7) correlate to those -regions which have the thinnest walls [778 microm (585-1120 microm)] in comparison to areas of lowest wall stress [1620 microm (962-2919 microm)]. Induced expression of Lamin A/C -correlated with areas of high wall stress from AAAs but was not significantly induced in the IMV from AAA patients compared to controls (n = 16). Stress-induced expression of Lamin A/C was mimicked by exposing aortic smooth muscle cells to prolonged pulsatile stretch. CONCLUSION: Lamin A/C protein is specifically increased in areas of high wall stress in AAA from patients, but is not increased on other vascular beds of aneurysm patients, suggesting that its elevation may be a compensatory response to the pathobiology leading to aneurysms.", "author" : [ { "dropping-particle" : "", "family" : "Malkawi", "given" : "A", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Pirianov", "given" : "G", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Torsney", "given" : "E", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Chetter", "given" : "I", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Sakalihasan", "given" : "N", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Loftus", "given" : "I M", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Nordon", "given" : "I", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Huggins", "given" : "C", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Charolidi", "given" : "N", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Thompson", "given" : "M", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Xu", "given" : "X Y", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Cockerill", "given" : "G W", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Aorta (Stamford)", "id" : "ITEM-2", "issue" : "5", "issued" : { "date-parts" : [ [ "2015" ] ] }, "note" : "Malkawi, Amir\nPirianov, Grisha\nTorsney, Evelyn\nChetter, Ian\nSakalihasan, Natzi\nLoftus, Ian M\nNordon, Ian\nHuggins, Christopher\nCharolidi, Nicoletta\nThompson, Matt\nXu, Xie Yun\nCockerill, Gillian W\neng\nStamford, Conn.\n2016/05/14 06:00\nAorta (Stamford). 2015 Oct 1;3(5):152-66. doi: 10.12945/j.aorta.2015.14.069. eCollection 2015 Oct.", "page" : "152-166", "title" : "Increased Expression of Lamin A/C Correlate with Regions of High Wall Stress in Abdominal Aortic Aneurysms", "type" : "article-journal", "volume" : "3" }, "uris" : [ "http://www.mendeley.com/documents/?uuid=598040ba-b8ad-4fa3-900e-da188c2360c1" ] } ], "mendeley" : { "formattedCitation" : "152,153", "plainTextFormattedCitation" : "152,153", "previouslyFormattedCitation" : "152,153" }, "properties" : { }, "schema" : "https://github.com/citation-style-language/schema/raw/master/csl-citation.json" }152,153 However, the relationship between elevated wall stress estimates and other hemodynamic parameters with rupture is not established. Indeed, areas of high wall stress spatially co-localize poorly with aortic wall blebsADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "S1078-5884(10)00136-X [pii] 10.1016/j.ejvs.2010.02.020", "ISBN" : "1532-2165 (Electronic) 1078-5884 (Linking)", "PMID" : "20303803", "author" : [ { "dropping-particle" : "", "family" : "Georgakarakos", "given" : "E", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Ioannou", "given" : "C", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Kostas", "given" : "T", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Katsamouris", "given" : "A", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Eur J Vasc Endovasc Surg", "edition" : "2010/03/23", "id" : "ITEM-1", "issue" : "6", "issued" : { "date-parts" : [ [ "2010" ] ] }, "language" : "eng", "note" : "Georgakarakos, E\nIoannou, C\nKostas, T\nKatsamouris, A\nComment\nLetter\nEngland\nEuropean journal of vascular and endovascular surgery : the official journal of the European Society for Vascular Surgery\nEur J Vasc Endovasc Surg. 2010 Jun;39(6):795; author reply 795-6. Epub 2010 Mar 19.", "page" : "795; author reply 795-6", "title" : "Inflammatory response to aortic aneurysm intraluminal thrombus may cause increased 18F-FDG uptake at sites not associated with high wall stress: comment on \"high levels of 18F-FDG uptake in aortic aneurysm wall are associated with high wall stress\"", "type" : "article-journal", "volume" : "39" }, "uris" : [ "http://www.mendeley.com/documents/?uuid=ef37fa09-a62f-4529-9ef9-b9a2b82252aa" ] } ], "mendeley" : { "formattedCitation" : "154", "plainTextFormattedCitation" : "154", "previouslyFormattedCitation" : "154" }, "properties" : { }, "schema" : "https://github.com/citation-style-language/schema/raw/master/csl-citation.json" }154 or inflammation as determined by either uptake of 18F-FDG on PET imaging or iron oxide on MRI.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1161/CIRCIMAGING.112.000415", "ISBN" : "1942-0080 (Electronic)\r1941-9651 (Linking)", "PMID" : "24190906", "abstract" : "BACKGROUND: The relationship between biomechanical properties and biological activities in aortic aneurysms was investigated with finite element simulations and 18F-fluoro-deoxy-glucose (18F-FDG) positron emission tomography. METHODS AND RESULTS: The study included 53 patients (45 men) with aortic aneurysms, 47 infrarenal (abdominal aortic) and 6 thoracic (thoracic aortic), who had >/=1 18F-FDG positron emission tomography/computed tomography. During a 30-month period, more clinical events occurred in patients with increased 18F-FDG uptake on their last examination than in those without (5 of 18 [28%] versus 2 of 35 [6%]; P=0.03). Wall stress and stress/strength index computed by finite element simulations and 18F-FDG uptake were evaluated in a total of 68 examinations. Twenty-five (38%) examinations demonstrated >/=1 aneurysm wall area of increased 18F-FDG uptake. The mean number of these areas per examination was 1.6 (18 of 11) in thoracic aortic aneurysms versus 0.25 (14 of 57) in abdominal aortic aneurysms, whereas the mean number of increased uptake areas colocalizing with highest wall stress and stress/strength index areas was 0.55 (6 of 11) and 0.02 (1 of 57), respectively. Quantitatively, 18F-FDG positron emission tomographic uptake correlated positively with both wall stress and stress/strength index (P<0.05). 18F-FDG uptake was particularly high in subjects with personal history of angina pectoris and familial aneurysm. CONCLUSIONS: Increased 18F-FDG positron emission tomographic uptake in aortic aneurysms is strongly related to aneurysm location, wall stress as derived by finite element simulations, and patient risk factors such as acquired and inherited susceptibilities.", "author" : [ { "dropping-particle" : "", "family" : "Nchimi", "given" : "A", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Cheramy-Bien", "given" : "J P", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Gasser", "given" : "T C", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Namur", "given" : "G", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Gomez", "given" : "P", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Seidel", "given" : "L", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Albert", "given" : "A", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Defraigne", "given" : "J O", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Labropoulos", "given" : "N", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Sakalihasan", "given" : "N", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Circ Cardiovasc Imaging", "id" : "ITEM-1", "issue" : "1", "issued" : { "date-parts" : [ [ "2014" ] ] }, "note" : "Nchimi, Alain\nCheramy-Bien, Jean-Paul\nGasser, T Christian\nNamur, Gauthier\nGomez, Pierre\nSeidel, Laurence\nAlbert, Adelin\nDefraigne, Jean-Olivier\nLabropoulos, Nicos\nSakalihasan, Natzi\neng\nResearch Support, Non-U.S. Gov't\n2013/11/06 06:00\nCirc Cardiovasc Imaging. 2014 Jan;7(1):82-91. doi: 10.1161/CIRCIMAGING.112.000415. Epub 2013 Nov 4.", "page" : "82-91", "title" : "Multifactorial relationship between 18F-fluoro-deoxy-glucose positron emission tomography signaling and biomechanical properties in unruptured aortic aneurysms", "type" : "article-journal", "volume" : "7" }, "uris" : [ "http://www.mendeley.com/documents/?uuid=f365bf6d-9436-4874-95a7-edf5d113815e" ] }, { "id" : "ITEM-2", "itemData" : { "DOI" : "10.1007/s12265-017-9766-9", "ISBN" : "1937-5395 (Electronic)\r1937-5387 (Linking)", "PMID" : "28808955", "abstract" : "Inflammation detected through the uptake of ultrasmall superparamagnetic particles of iron oxide (USPIO) on magnetic resonance imaging (MRI) and finite element (FE) modelling of tissue stress both hold potential in the assessment of abdominal aortic aneurysm (AAA) rupture risk. This study aimed to examine the spatial relationship between these two biomarkers. Patients (n = 50) > 40 years with AAA maximum diameters > = 40 mm underwent USPIO-enhanced MRI and computed tomography angiogram (CTA). USPIO uptake was compared with wall stress predictions from CTA-based patient-specific FE models of each aneurysm. Elevated stress was commonly observed in areas vulnerable to rupture (e.g. posterior wall and shoulder). Only 16% of aneurysms exhibited co-localisation of elevated stress and mural USPIO enhancement. Globally, no correlation was observed between stress and other measures of USPIO uptake (i.e. mean or peak). It is suggested that cellular inflammation and stress may represent different but complimentary aspects of AAA disease progression.", "author" : [ { "dropping-particle" : "", "family" : "Conlisk", "given" : "N", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Forsythe", "given" : "R O", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Hollis", "given" : "L", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Doyle", "given" : "B J", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "McBride", "given" : "O M B", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Robson", "given" : "J M J", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Wang", "given" : "C", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Gray", "given" : "C D", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Semple", "given" : "S I K", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "MacGillivray", "given" : "T", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Beek", "given" : "E J R", "non-dropping-particle" : "van", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Newby", "given" : "D E", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Hoskins", "given" : "P R", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "J Cardiovasc Transl Res", "id" : "ITEM-2", "issue" : "5-6", "issued" : { "date-parts" : [ [ "2017" ] ] }, "note" : "Conlisk, Noel\nForsythe, Rachael O\nHollis, Lyam\nDoyle, Barry J\nMcBride, Olivia M B\nRobson, Jennifer M J\nWang, Chengjia\nGray, Calum D\nSemple, Scott I K\nMacGillivray, Tom\nvan Beek, Edwin J R\nNewby, David E\nHoskins, Peter R\neng\nNIHR EME 11/20/03/Efficacy and Mechanism Evaluation Programme/\n2017/08/16 06:00\nJ Cardiovasc Transl Res. 2017 Dec;10(5-6):489-498. doi: 10.1007/s12265-017-9766-9. Epub 2017 Aug 14.", "page" : "489-498", "title" : "Exploring the Biological and Mechanical Properties of Abdominal Aortic Aneurysms Using USPIO MRI and Peak Tissue Stress: A Combined Clinical and Finite Element Study", "type" : "article-journal", "volume" : "10" }, "uris" : [ "http://www.mendeley.com/documents/?uuid=326289e4-4c33-4d31-9192-c3cbe26e7b4d" ] } ], "mendeley" : { "formattedCitation" : "155,156", "plainTextFormattedCitation" : "155,156", "previouslyFormattedCitation" : "155,156" }, "properties" : { }, "schema" : "https://github.com/citation-style-language/schema/raw/master/csl-citation.json" }155,156 Thus, inflammation and wall stress may represent different but complementary features of AAA progression.
[H2] Screening
Knowledge of the natural history of AAA has vastly improved from the large AAA screening and surveillance trials.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1002/bjs.5780", "ISBN" : "0007-1323 (Print) 0007-1323 (Linking)", "PMID" : "17514666", "abstract" : "BACKGROUND: Long-term benefits of screening for abdominal aortic aneurysm (AAA) are uncertain. These are the final results of a randomized controlled screening trial for AAA in men, updating those reported previously. Benefit and compliance over a median 15-year interval were examined. METHODS: One group of men were invited for ultrasonographic AAA screening, and another group, who received standard care, acted as controls. A total of 6040 men aged 65-80 years were randomized to one of the two groups. Outcome was monitored in terms of AAA-related events (surgery or death). RESULTS: In the group invited for screening, AAA-related mortality was reduced by 11 per cent (from 1.8 to 1.6 per cent, hazard ratio 0.89) over the follow-up interval. Screening detected an AAA in 170 patients; 17 of these died from an AAA-related cause, seven of which might have been preventable. The incidence of AAA rupture after an initially normal scan increased after 10 years of follow-up, but was still low overall (0.56 per 1000 person-years). CONCLUSION: Screening with a single ultrasonography scan still conferred a benefit at 15 years, although the results were not significant for this population size. Fewer than half of the AAA-related deaths in those screened positive could be prevented. Registration number: ISRCTN 00079388 (http://www.controlled-trials.com).", "author" : [ { "dropping-particle" : "", "family" : "Ashton", "given" : "H A", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Gao", "given" : "L", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Kim", "given" : "L G", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Druce", "given" : "P S", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Thompson", "given" : "S G", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Scott", "given" : "R A", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Br J Surg", "edition" : "2007/05/22", "id" : "ITEM-1", "issue" : "6", "issued" : { "date-parts" : [ [ "2007" ] ] }, "language" : "eng", "note" : "Ashton, H A\nGao, L\nKim, L G\nDruce, P S\nThompson, S G\nScott, R A P\nMulticenter Study\nRandomized Controlled Trial\nResearch Support, Non-U.S. Gov't\nEngland\nThe British journal of surgery\nBr J Surg. 2007 Jun;94(6):696-701.", "page" : "696-701", "title" : "Fifteen-year follow-up of a randomized clinical trial of ultrasonographic screening for abdominal aortic aneurysms", "type" : "article-journal", "volume" : "94" }, "uris" : [ "http://www.mendeley.com/documents/?uuid=76e1b447-ec54-4089-83ba-952125fba15c" ] }, { "id" : "ITEM-2", "itemData" : { "DOI" : "10.1002/bjs.10715", "ISBN" : "1365-2168 (Electronic)\r0007-1323 (Linking)", "PMID" : "29265406", "abstract" : "BACKGROUND: This study aimed to assess how the prevalence and growth rates of small and medium abdominal aortic aneurysms (AAAs) (3.0-5.4 cm) have changed over time in men aged 65 years, and to evaluate long-term outcomes in men whose aortic diameter is 2.6-2.9 cm (subaneurysmal), and below the standard threshold for most surveillance programmes. METHODS: The Gloucestershire Aneurysm Screening Programme (GASP) started in 1990. Men aged 65 years with an aortic diameter of 2.6-5.4 cm, measured by ultrasonography using the inner to inner wall method, were included in surveillance. Aortic diameter growth rates were estimated separately for men who initially had a subaneurysmal aorta, and those who had a small or medium AAA, using mixed-effects models. RESULTS: Since 1990, 81 150 men had ultrasound screening for AAA (uptake 80.7 per cent), of whom 2795 had an aortic diameter of 2.6-5.4 cm. The prevalence of screen-detected AAA of 3.0 cm or larger decreased from 5.0 per cent in 1991 to 1.3 per cent in 2015. There was no evidence of a change in AAA growth rates during this time. Of men who initially had a subaneurysmal aorta, 57.6 (95 per cent c.i. 54.4 to 60.7) per cent were estimated to develop an AAA of 3.0 cm or larger within 5 years of the initial scan, and 28.0 (24.2 to 31.8) per cent to develop a large AAA (at least 5.5 cm) within 15 years. CONCLUSION: The prevalence of screen-detected small and medium AAAs has decreased over the past 25 years, but growth rates have remained similar. Men with a subaneurysmal aorta at age 65 years have a substantial risk of developing a large AAA by the age of 80 years.", "author" : [ { "dropping-particle" : "", "family" : "Oliver-Williams", "given" : "C", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Sweeting", "given" : "M J", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Turton", "given" : "G", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Parkin", "given" : "D", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Cooper", "given" : "D", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Rodd", "given" : "C", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Thompson", "given" : "S G", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Earnshaw", "given" : "J J", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Gloucestershire", "given" : "", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Swindon Abdominal Aortic Aneurysm Screening", "given" : "Programme", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Br J Surg", "id" : "ITEM-2", "issue" : "1", "issued" : { "date-parts" : [ [ "2018" ] ] }, "note" : "Oliver-Williams, C\nSweeting, M J\nTurton, G\nParkin, D\nCooper, D\nRodd, C\nThompson, S G\nEarnshaw, J J\neng\nEngland\n2017/12/22 06:00\nBr J Surg. 2018 Jan;105(1):68-74. doi: 10.1002/bjs.10715.", "page" : "68-74", "title" : "Lessons learned about prevalence and growth rates of abdominal aortic aneurysms from a 25-year ultrasound population screening programme", "type" : "article-journal", "volume" : "105" }, "uris" : [ "http://www.mendeley.com/documents/?uuid=67612048-6c73-43f5-896a-6a7221a7aaba" ] }, { "id" : "ITEM-3", "itemData" : { "DOI" : "10.1002/bjs.5778", "ISBN" : "0007-1323 (Print)\r0007-1323 (Linking)", "PMID" : "17514693", "abstract" : "BACKGROUND: The aim was to determine whether early open surgical repair would benefit patients with small abdominal aortic aneurysm compared with surveillance on long-term follow-up. METHODS: The 1090 patients who were enrolled into the UK Small Aneurysm Trial between 1991 and 1995 were followed up for aneurysm repair and mortality until November 2005. RESULTS: By November 2005, 714 patients (65.5 per cent) had died, 929 (85.2 per cent) had undergone aneurysm repair, 150 (13.8 per cent) had died without aneurysm repair and 11 (1.0 per cent) remained alive without aneurysm repair. After 12 years, mortality in the surgery and surveillance groups was 63.9 and 67.3 per cent respectively, unadjusted hazard ratio 0.90 (P = 0.139). Three-quarters of the surveillance group eventually had aneurysm repair, with a 30-day elective mortality of 6.3 per cent (versus 5.0 per cent in the early surgery group, P = 0.366). Estimates suggested that the cost of treatment was 17 per cent higher in the early surgery group, with a mean difference of 1326 pounds. The death rate in these patients was about twice that in the population matched for age and sex. CONCLUSION: There was no long-term survival benefit of early elective open repair of small abdominal aortic aneurysms. Even after successful aneurysm repair, the mortality among these patients was higher than in the general population.", "author" : [ { "dropping-particle" : "", "family" : "Powell", "given" : "J T", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Brown", "given" : "L C", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Forbes", "given" : "J F", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Fowkes", "given" : "F G", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Greenhalgh", "given" : "R M", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "V", "family" : "Ruckley", "given" : "C", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Thompson", "given" : "S G", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Br J Surg", "id" : "ITEM-3", "issue" : "6", "issued" : { "date-parts" : [ [ "2007" ] ] }, "note" : "Powell, J T\nBrown, L C\nForbes, J F\nFowkes, F G R\nGreenhalgh, R M\nRuckley, C V\nThompson, S G\neng\nMC_U105260792/Medical Research Council/United Kingdom\nMulticenter Study\nRandomized Controlled Trial\nResearch Support, Non-U.S. Gov't\nEngland\n2007/05/22 09:00\nBr J Surg. 2007 Jun;94(6):702-8. doi: 10.1002/bjs.5778.", "page" : "702-708", "title" : "Final 12-year follow-up of surgery versus surveillance in the UK Small Aneurysm Trial", "type" : "article-journal", "volume" : "94" }, "uris" : [ "http://www.mendeley.com/documents/?uuid=adcd2d7e-8a9b-4031-bfed-597487a0d717" ] } ], "mendeley" : { "formattedCitation" : "8,42,43", "plainTextFormattedCitation" : "8,42,43", "previouslyFormattedCitation" : "8,42,43" }, "properties" : { }, "schema" : "https://github.com/citation-style-language/schema/raw/master/csl-citation.json" }8,42,43 The maximum aortic diameter at the latest control will influence the surveillance interval. Surveillance protocols are commonly used at most vascular departments for patients with asymptomatic AAA and also indicate when patients should be evaluated for aortic repair.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "S0140-6736(05)66459-8 [pii] 10.1016/S0140-6736(05)66459-8 [doi]", "ISBN" : "1474-547X (Electronic) 0140-6736 (Linking)", "PMID" : "15866312", "abstract" : "Abdominal aortic aneurysms cause 1.3% of all deaths among men aged 65-85 years in developed countries. These aneurysms are typically asymptomatic until the catastrophic event of rupture. Repair of large or symptomatic aneurysms by open surgery or endovascular repair is recommended, whereas repair of small abdominal aortic aneurysms does not provide a significant benefit. Abdominal aortic aneurysm is linked to the degradation of the elastic media of the atheromatous aorta. An inflammatory cell infiltrate, neovascularisation, and production and activation of various proteases and cytokines contribute to the development of this disorder, although the underlying mechanisms are unknown. In this Seminar, we aim to provide an updated review of the pathophysiology, current and new diagnostic procedures, assessment, and treatment of abdominal aortic aneurysm to provide family practitioners with a working knowledge of this disorder.", "author" : [ { "dropping-particle" : "", "family" : "Sakalihasan", "given" : "N", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Limet", "given" : "R", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Defawe", "given" : "O D", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Lancet", "edition" : "2005/05/04", "id" : "ITEM-1", "issue" : "9470", "issued" : { "date-parts" : [ [ "2005" ] ] }, "language" : "eng", "note" : "Sakalihasan, N\nLimet, R\nDefawe, O D\nResearch Support, Non-U.S. Gov't\nReview\nEngland\nLancet\nLancet. 2005 Apr 30-May 6;365(9470):1577-89.", "page" : "1577-1589", "title" : "Abdominal aortic aneurysm", "type" : "article-journal", "volume" : "365" }, "uris" : [ "http://www.mendeley.com/documents/?uuid=0fcf1cfb-3c11-43fa-9d25-2c4a31838a62" ] } ], "mendeley" : { "formattedCitation" : "46", "plainTextFormattedCitation" : "46", "previouslyFormattedCitation" : "46" }, "properties" : { }, "schema" : "https://github.com/citation-style-language/schema/raw/master/csl-citation.json" }46 (Figure 8) Population-based screening has been shown to reduce AAA-related mortality in men. Such screening programmes have been implemented nationally in the UK and Sweden, inviting all 65-year old men to a one-time ultrasonography scan.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1002/bjs.5780", "ISBN" : "0007-1323 (Print) 0007-1323 (Linking)", "PMID" : "17514666", "abstract" : "BACKGROUND: Long-term benefits of screening for abdominal aortic aneurysm (AAA) are uncertain. These are the final results of a randomized controlled screening trial for AAA in men, updating those reported previously. Benefit and compliance over a median 15-year interval were examined. METHODS: One group of men were invited for ultrasonographic AAA screening, and another group, who received standard care, acted as controls. A total of 6040 men aged 65-80 years were randomized to one of the two groups. Outcome was monitored in terms of AAA-related events (surgery or death). RESULTS: In the group invited for screening, AAA-related mortality was reduced by 11 per cent (from 1.8 to 1.6 per cent, hazard ratio 0.89) over the follow-up interval. Screening detected an AAA in 170 patients; 17 of these died from an AAA-related cause, seven of which might have been preventable. The incidence of AAA rupture after an initially normal scan increased after 10 years of follow-up, but was still low overall (0.56 per 1000 person-years). CONCLUSION: Screening with a single ultrasonography scan still conferred a benefit at 15 years, although the results were not significant for this population size. Fewer than half of the AAA-related deaths in those screened positive could be prevented. Registration number: ISRCTN 00079388 (http://www.controlled-trials.com).", "author" : [ { "dropping-particle" : "", "family" : "Ashton", "given" : "H A", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Gao", "given" : "L", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Kim", "given" : "L G", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Druce", "given" : "P S", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Thompson", "given" : "S G", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Scott", "given" : "R A", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Br J Surg", "edition" : "2007/05/22", "id" : "ITEM-1", "issue" : "6", "issued" : { "date-parts" : [ [ "2007" ] ] }, "language" : "eng", "note" : "Ashton, H A\nGao, L\nKim, L G\nDruce, P S\nThompson, S G\nScott, R A P\nMulticenter Study\nRandomized Controlled Trial\nResearch Support, Non-U.S. Gov't\nEngland\nThe British journal of surgery\nBr J Surg. 2007 Jun;94(6):696-701.", "page" : "696-701", "title" : "Fifteen-year follow-up of a randomized clinical trial of ultrasonographic screening for abdominal aortic aneurysms", "type" : "article-journal", "volume" : "94" }, "uris" : [ "http://www.mendeley.com/documents/?uuid=76e1b447-ec54-4089-83ba-952125fba15c" ] }, { "id" : "ITEM-2", "itemData" : { "DOI" : "10.1161/CIRCULATIONAHA.116.022305", "ISBN" : "1524-4539 (Electronic)\r0009-7322 (Linking)", "PMID" : "27630132", "abstract" : "BACKGROUND: A general abdominal aortic aneurysm (AAA) screening program, targeting 65-year-old men, has gradually been introduced in Sweden since 2006 and reached nationwide coverage in 2015. The aim of this study was to determine the outcome of this program. METHODS: Data on the number of invited and examined men, screening-detected AAAs, AAAs operated on, and surgical outcome were retrieved from all 21 Swedish counties for the years 2006 through 2014. AAA-specific mortality data were retrieved from the Swedish Cause of Death Registry. A linear regression analysis was used to estimate the effect on AAA-specific mortality among all men >/=65 years of age for the observed time period. The long-term effects were projected by using a validated Markov model. RESULTS: Of 302 957 men aged 65 years invited, 84% attended. The prevalence of screening-detected AAA was 1.5%. After a mean of 4.5 years, 29% of patients with AAA had been operated on, with a 30-day mortality rate of 0.9% (1.3% after open repair and 0.3% after endovascular repair, P<0.001). The introduction of screening was associated with a significant reduction in AAA-specific mortality (mean, 4.0% per year of screening, P=0.020). The number needed to screen and the number needed to operate on to prevent 1 premature death were 667 and 1.5, respectively. With a total population of 9.5 million, the Swedish national AAA-screening program was predicted to annually prevent 90 premature deaths from AAA and to gain 577 quality-adjusted life-years. The incremental cost-efficiency ratio was estimated to be euro7770 per quality-adjusted life-years. CONCLUSIONS: Screening 65-year-old men for AAA is an effective preventive health measure and is highly cost-effective in a contemporary setting. These findings confirm the results from earlier randomized controlled trials and model studies in a large population-based setting of the importance for future healthcare decision making.", "author" : [ { "dropping-particle" : "", "family" : "Wanhainen", "given" : "A", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Hultgren", "given" : "R", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Linne", "given" : "A", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Holst", "given" : "J", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Gottsater", "given" : "A", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Langenskiold", "given" : "M", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Smidfelt", "given" : "K", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Bjorck", "given" : "M", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Svensjo", "given" : "S", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Swedish Aneurysm Screening Study", "given" : "Group", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Circulation", "id" : "ITEM-2", "issue" : "16", "issued" : { "date-parts" : [ [ "2016" ] ] }, "note" : "Wanhainen, Anders\nHultgren, Rebecka\nLinne, Anneli\nHolst, Jan\nGottsater, Anders\nLangenskiold, Marcus\nSmidfelt, Kristian\nBjorck, Martin\nSvensjo, Sverker\n(SASS)\neng\n2016/10/19 06:00\nCirculation. 2016 Oct 18;134(16):1141-1148. doi: 10.1161/CIRCULATIONAHA.116.022305. Epub 2016 Sep 14.", "page" : "1141-1148", "title" : "Outcome of the Swedish Nationwide Abdominal Aortic Aneurysm Screening Program", "type" : "article-journal", "volume" : "134" }, "uris" : [ "http://www.mendeley.com/documents/?uuid=0a65ec7f-1fdf-4c3b-9b9b-f15d93ec5108" ] }, { "id" : "ITEM-3", "itemData" : { "DOI" : "10.1002/bjs.10715", "ISBN" : "1365-2168 (Electronic)\r0007-1323 (Linking)", "PMID" : "29265406", "abstract" : "BACKGROUND: This study aimed to assess how the prevalence and growth rates of small and medium abdominal aortic aneurysms (AAAs) (3.0-5.4 cm) have changed over time in men aged 65 years, and to evaluate long-term outcomes in men whose aortic diameter is 2.6-2.9 cm (subaneurysmal), and below the standard threshold for most surveillance programmes. METHODS: The Gloucestershire Aneurysm Screening Programme (GASP) started in 1990. Men aged 65 years with an aortic diameter of 2.6-5.4 cm, measured by ultrasonography using the inner to inner wall method, were included in surveillance. Aortic diameter growth rates were estimated separately for men who initially had a subaneurysmal aorta, and those who had a small or medium AAA, using mixed-effects models. RESULTS: Since 1990, 81 150 men had ultrasound screening for AAA (uptake 80.7 per cent), of whom 2795 had an aortic diameter of 2.6-5.4 cm. The prevalence of screen-detected AAA of 3.0 cm or larger decreased from 5.0 per cent in 1991 to 1.3 per cent in 2015. There was no evidence of a change in AAA growth rates during this time. Of men who initially had a subaneurysmal aorta, 57.6 (95 per cent c.i. 54.4 to 60.7) per cent were estimated to develop an AAA of 3.0 cm or larger within 5 years of the initial scan, and 28.0 (24.2 to 31.8) per cent to develop a large AAA (at least 5.5 cm) within 15 years. CONCLUSION: The prevalence of screen-detected small and medium AAAs has decreased over the past 25 years, but growth rates have remained similar. Men with a subaneurysmal aorta at age 65 years have a substantial risk of developing a large AAA by the age of 80 years.", "author" : [ { "dropping-particle" : "", "family" : "Oliver-Williams", "given" : "C", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Sweeting", "given" : "M J", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Turton", "given" : "G", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Parkin", "given" : "D", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Cooper", "given" : "D", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Rodd", "given" : "C", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Thompson", "given" : "S G", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Earnshaw", "given" : "J J", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Gloucestershire", "given" : "", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Swindon Abdominal Aortic Aneurysm Screening", "given" : "Programme", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Br J Surg", "id" : "ITEM-3", "issue" : "1", "issued" : { "date-parts" : [ [ "2018" ] ] }, "note" : "Oliver-Williams, C\nSweeting, M J\nTurton, G\nParkin, D\nCooper, D\nRodd, C\nThompson, S G\nEarnshaw, J J\neng\nEngland\n2017/12/22 06:00\nBr J Surg. 2018 Jan;105(1):68-74. doi: 10.1002/bjs.10715.", "page" : "68-74", "title" : "Lessons learned about prevalence and growth rates of abdominal aortic aneurysms from a 25-year ultrasound population screening programme", "type" : "article-journal", "volume" : "105" }, "uris" : [ "http://www.mendeley.com/documents/?uuid=67612048-6c73-43f5-896a-6a7221a7aaba" ] }, { "id" : "ITEM-4", "itemData" : { "ISBN" : "0959-8138 (Print)\r0959-535X (Linking)", "PMID" : "9748177", "abstract" : "OBJECTIVE: To determine the long term relative survival of all patients who had surgery for abdominal aortic aneurysm in Western Australia during 1985-94. DESIGN: Population based study. SETTING: Western Australia. SUBJECTS: All patients who had had surgery for abdominal aortic aneurysm in Western Australia during 1985-94. MAIN OUTCOME MEASURES: Morbidity and mortality data of patients admitted and surgically treated for abdominal aortic aneurysm in Western Australia during 1985-94. Elective, ruptured, and acute non-ruptured cases were analysed separately. Independent analyses for sex and patients aged 80 years or more were also undertaken. Postoperative (>30 days) relative survival was assessed against age and sex matched controls. RESULTS: Overall, 1475 (1257 men, 218 women) cases were identified. The crude five year survival after elective surgery, including deaths within 30 days of surgery, was 79% for both men and women. When compared with a matched population the five year relative survival after elective surgery was 94.9% (95% confidence interval 89.9% to 99.9%) for men but only 88.0% (76.3% to 99.7%) for women. The five year relative survival of those aged 80 years and over was good: 116.6% (89.1% to 144.0%) compared with 92.4% (87.7% to 97.0%) for those under 80 years of age (men and women combined). Cardiovascular disease caused 57.8% of the 341 deaths after 30 days. CONCLUSION: In a condition such as abdominal aortic aneurysm, which occurs in elderly patients, relative survival is more clinically meaningful than crude survival. The five year relative survival in cases of elective and ruptured abdominal aortic aneurysm was better in men than in women. This is probably because of greater comorbidity in women with abdominal aortic aneurysm and this deserves more attention in the future. The long term survival outcome in octogenarians supports surgery in selected cases.", "author" : [ { "dropping-particle" : "", "family" : "Norman", "given" : "P E", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Semmens", "given" : "J B", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Lawrence-Brown", "given" : "M M", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Holman", "given" : "C D", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "BMJ", "id" : "ITEM-4", "issue" : "7162", "issued" : { "date-parts" : [ [ "1998" ] ] }, "note" : "Norman, P E\nSemmens, J B\nLawrence-Brown, M M\nHolman, C D\neng\nResearch Support, Non-U.S. Gov't\nEngland\nClinical research ed.\n1998/09/25 00:00\nBMJ. 1998 Sep 26;317(7162):852-6.", "page" : "852-856", "title" : "Long term relative survival after surgery for abdominal aortic aneurysm in western Australia: population based study", "type" : "article-journal", "volume" : "317" }, "uris" : [ "http://www.mendeley.com/documents/?uuid=42a7df83-2e2d-4c23-b7cc-42e0b6228bab" ] } ], "mendeley" : { "formattedCitation" : "8,42,50,115", "plainTextFormattedCitation" : "8,42,50,115", "previouslyFormattedCitation" : "8,42,50,115" }, "properties" : { }, "schema" : "https://github.com/citation-style-language/schema/raw/master/csl-citation.json" }8,42,50,115 The gold standard diagnostic method is ultrasonography. The participation rate in the UK and Sweden was 75-85% and the prevalence of AAA in the target population was 1-2%. However, large regional variations are often found both in prevalence and participation rates.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1002/bjs.5780", "ISBN" : "0007-1323 (Print) 0007-1323 (Linking)", "PMID" : "17514666", "abstract" : "BACKGROUND: Long-term benefits of screening for abdominal aortic aneurysm (AAA) are uncertain. These are the final results of a randomized controlled screening trial for AAA in men, updating those reported previously. Benefit and compliance over a median 15-year interval were examined. METHODS: One group of men were invited for ultrasonographic AAA screening, and another group, who received standard care, acted as controls. A total of 6040 men aged 65-80 years were randomized to one of the two groups. Outcome was monitored in terms of AAA-related events (surgery or death). RESULTS: In the group invited for screening, AAA-related mortality was reduced by 11 per cent (from 1.8 to 1.6 per cent, hazard ratio 0.89) over the follow-up interval. Screening detected an AAA in 170 patients; 17 of these died from an AAA-related cause, seven of which might have been preventable. The incidence of AAA rupture after an initially normal scan increased after 10 years of follow-up, but was still low overall (0.56 per 1000 person-years). CONCLUSION: Screening with a single ultrasonography scan still conferred a benefit at 15 years, although the results were not significant for this population size. Fewer than half of the AAA-related deaths in those screened positive could be prevented. Registration number: ISRCTN 00079388 (http://www.controlled-trials.com).", "author" : [ { "dropping-particle" : "", "family" : "Ashton", "given" : "H A", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Gao", "given" : "L", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Kim", "given" : "L G", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Druce", "given" : "P S", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Thompson", "given" : "S G", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Scott", "given" : "R A", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Br J Surg", "edition" : "2007/05/22", "id" : "ITEM-1", "issue" : "6", "issued" : { "date-parts" : [ [ "2007" ] ] }, "language" : "eng", "note" : "Ashton, H A\nGao, L\nKim, L G\nDruce, P S\nThompson, S G\nScott, R A P\nMulticenter Study\nRandomized Controlled Trial\nResearch Support, Non-U.S. Gov't\nEngland\nThe British journal of surgery\nBr J Surg. 2007 Jun;94(6):696-701.", "page" : "696-701", "title" : "Fifteen-year follow-up of a randomized clinical trial of ultrasonographic screening for abdominal aortic aneurysms", "type" : "article-journal", "volume" : "94" }, "uris" : [ "http://www.mendeley.com/documents/?uuid=76e1b447-ec54-4089-83ba-952125fba15c" ] }, { "id" : "ITEM-2", "itemData" : { "DOI" : "10.1002/bjs.10715", "ISBN" : "1365-2168 (Electronic)\r0007-1323 (Linking)", "PMID" : "29265406", "abstract" : "BACKGROUND: This study aimed to assess how the prevalence and growth rates of small and medium abdominal aortic aneurysms (AAAs) (3.0-5.4 cm) have changed over time in men aged 65 years, and to evaluate long-term outcomes in men whose aortic diameter is 2.6-2.9 cm (subaneurysmal), and below the standard threshold for most surveillance programmes. METHODS: The Gloucestershire Aneurysm Screening Programme (GASP) started in 1990. Men aged 65 years with an aortic diameter of 2.6-5.4 cm, measured by ultrasonography using the inner to inner wall method, were included in surveillance. Aortic diameter growth rates were estimated separately for men who initially had a subaneurysmal aorta, and those who had a small or medium AAA, using mixed-effects models. RESULTS: Since 1990, 81 150 men had ultrasound screening for AAA (uptake 80.7 per cent), of whom 2795 had an aortic diameter of 2.6-5.4 cm. The prevalence of screen-detected AAA of 3.0 cm or larger decreased from 5.0 per cent in 1991 to 1.3 per cent in 2015. There was no evidence of a change in AAA growth rates during this time. Of men who initially had a subaneurysmal aorta, 57.6 (95 per cent c.i. 54.4 to 60.7) per cent were estimated to develop an AAA of 3.0 cm or larger within 5 years of the initial scan, and 28.0 (24.2 to 31.8) per cent to develop a large AAA (at least 5.5 cm) within 15 years. CONCLUSION: The prevalence of screen-detected small and medium AAAs has decreased over the past 25 years, but growth rates have remained similar. Men with a subaneurysmal aorta at age 65 years have a substantial risk of developing a large AAA by the age of 80 years.", "author" : [ { "dropping-particle" : "", "family" : "Oliver-Williams", "given" : "C", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Sweeting", "given" : "M J", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Turton", "given" : "G", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Parkin", "given" : "D", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Cooper", "given" : "D", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Rodd", "given" : "C", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Thompson", "given" : "S G", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Earnshaw", "given" : "J J", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Gloucestershire", "given" : "", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Swindon Abdominal Aortic Aneurysm Screening", "given" : "Programme", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Br J Surg", "id" : "ITEM-2", "issue" : "1", "issued" : { "date-parts" : [ [ "2018" ] ] }, "note" : "Oliver-Williams, C\nSweeting, M J\nTurton, G\nParkin, D\nCooper, D\nRodd, C\nThompson, S G\nEarnshaw, J J\neng\nEngland\n2017/12/22 06:00\nBr J Surg. 2018 Jan;105(1):68-74. doi: 10.1002/bjs.10715.", "page" : "68-74", "title" : "Lessons learned about prevalence and growth rates of abdominal aortic aneurysms from a 25-year ultrasound population screening programme", "type" : "article-journal", "volume" : "105" }, "uris" : [ "http://www.mendeley.com/documents/?uuid=67612048-6c73-43f5-896a-6a7221a7aaba" ] }, { "id" : "ITEM-3", "itemData" : { "DOI" : "10.1186/s12872-018-0758-8", "ISBN" : "1471-2261 (Electronic)\r1471-2261 (Linking)", "PMID" : "29402233", "abstract" : "BACKGROUND: Reducing women's cardiovascular risk and the economic costs associated with cardiovascular diseases (CVD) and diabetes (DM) continues to be a challenge. Whether a multifaceted CVD screening programme is beneficial as a preventive strategy in women remains uncertain. The aim of this study was to investigate the prevalence of CVD and DM as well as the acceptability toward screening and preventive actions. METHODS: An observational study was performed among all women born in 1936, 1941, 1946 and 1951 living in Viborg Municipality, Denmark, from October 2011. In total, 1984 were invited to screening for abdominal aortic aneurysm (AAA), peripheral arterial disease (PAD), carotid plaque (CP), hypertension (HT), atrial fibrillation (AF), DM and dyslipidaemia. Participants with positive tests were offered prophylactic intervention including follow-up consultations in case of AAA, PAD and/or CP. Participants with AAA >/= 50 mm were referred to specialists in vascular surgery. Women with AF or potential familial hypercholesterolaemia (FH) were referred to cardiology work-up. RESULTS: Among those invited, 1474 (74.3%) attended screening, but the attendees' share decreased with increasing age groups (p < 0.001). AAA was diagnosed in 10 (0.7%) women, PAD in 101 (6.9%) and CP in 602 (40.8%). The percentage of women with these conditions rose with increasing age group (p < 0.05). Unconfirmed potential HT was observed in 94 (6.4%), unknown AF in 6 (0.4%), DM in 14 (1%) and potential FH in 35 (2.4%). None of these findings differed across age groups. Among the 631 women diagnosed with AAA, PAD and/or CP, 182 (28.8%) were already in antiplatelet and 223 (35.3%) in lipid-lowering therapy prior to screening. Antiplatelet therapy was initiated in 215 (34.1%) and lipid-lowering therapy in 191 (30.3%) women. Initiation of antiplatelet and lipid-lowering therapy was further recommended to 134 (21.2%) and 141 (22.4%) women, respectively, who hesitated to follow the recommendation. CONCLUSIONS: The study recorded an acceptable total attendance rate, even though a significantly lower attendance rate was observed in the eldest women. The identified hesitation towards prophylactic therapy may affect the rationale and effectiveness of CVD screening, and hesitation seems a critical issue that should be addressed in the design of future screening programmes.", "author" : [ { "dropping-particle" : "", "family" : "Dahl", "given" : "M", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Frost", "given" : "L", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Sogaard", "given" : "R", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Klausen", "given" : "I C", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Lorentzen", "given" : "V", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Lindholt", "given" : "J", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "BMC Cardiovasc Disord", "id" : "ITEM-3", "issue" : "1", "issued" : { "date-parts" : [ [ "2018" ] ] }, "note" : "Dahl, Marie\nFrost, Lars\nSogaard, Rikke\nKlausen, Ib Christian\nLorentzen, Vibeke\nLindholt, Jes\neng\nResearch Support, Non-U.S. Gov't\nEngland\n2018/02/07 06:00\nBMC Cardiovasc Disord. 2018 Feb 5;18(1):20. doi: 10.1186/s12872-018-0758-8.", "page" : "20", "title" : "A population-based screening study for cardiovascular diseases and diabetes in Danish postmenopausal women: acceptability and prevalence", "type" : "article-journal", "volume" : "18" }, "uris" : [ "http://www.mendeley.com/documents/?uuid=8e0825ea-243e-426d-affe-fc348cb2e61a" ] }, { "id" : "ITEM-4", "itemData" : { "ISBN" : "0959-8138 (Print)\r0959-535X (Linking)", "PMID" : "9748177", "abstract" : "OBJECTIVE: To determine the long term relative survival of all patients who had surgery for abdominal aortic aneurysm in Western Australia during 1985-94. DESIGN: Population based study. SETTING: Western Australia. SUBJECTS: All patients who had had surgery for abdominal aortic aneurysm in Western Australia during 1985-94. MAIN OUTCOME MEASURES: Morbidity and mortality data of patients admitted and surgically treated for abdominal aortic aneurysm in Western Australia during 1985-94. Elective, ruptured, and acute non-ruptured cases were analysed separately. Independent analyses for sex and patients aged 80 years or more were also undertaken. Postoperative (>30 days) relative survival was assessed against age and sex matched controls. RESULTS: Overall, 1475 (1257 men, 218 women) cases were identified. The crude five year survival after elective surgery, including deaths within 30 days of surgery, was 79% for both men and women. When compared with a matched population the five year relative survival after elective surgery was 94.9% (95% confidence interval 89.9% to 99.9%) for men but only 88.0% (76.3% to 99.7%) for women. The five year relative survival of those aged 80 years and over was good: 116.6% (89.1% to 144.0%) compared with 92.4% (87.7% to 97.0%) for those under 80 years of age (men and women combined). Cardiovascular disease caused 57.8% of the 341 deaths after 30 days. CONCLUSION: In a condition such as abdominal aortic aneurysm, which occurs in elderly patients, relative survival is more clinically meaningful than crude survival. The five year relative survival in cases of elective and ruptured abdominal aortic aneurysm was better in men than in women. This is probably because of greater comorbidity in women with abdominal aortic aneurysm and this deserves more attention in the future. The long term survival outcome in octogenarians supports surgery in selected cases.", "author" : [ { "dropping-particle" : "", "family" : "Norman", "given" : "P E", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Semmens", "given" : "J B", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Lawrence-Brown", "given" : "M M", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Holman", "given" : "C D", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "BMJ", "id" : "ITEM-4", "issue" : "7162", "issued" : { "date-parts" : [ [ "1998" ] ] }, "note" : "Norman, P E\nSemmens, J B\nLawrence-Brown, M M\nHolman, C D\neng\nResearch Support, Non-U.S. Gov't\nEngland\nClinical research ed.\n1998/09/25 00:00\nBMJ. 1998 Sep 26;317(7162):852-6.", "page" : "852-856", "title" : "Long term relative survival after surgery for abdominal aortic aneurysm in western Australia: population based study", "type" : "article-journal", "volume" : "317" }, "uris" : [ "http://www.mendeley.com/documents/?uuid=42a7df83-2e2d-4c23-b7cc-42e0b6228bab" ] }, { "id" : "ITEM-5", "itemData" : { "DOI" : "10.1161/CIRCULATIONAHA.116.022305", "ISBN" : "1524-4539 (Electronic)\r0009-7322 (Linking)", "PMID" : "27630132", "abstract" : "BACKGROUND: A general abdominal aortic aneurysm (AAA) screening program, targeting 65-year-old men, has gradually been introduced in Sweden since 2006 and reached nationwide coverage in 2015. The aim of this study was to determine the outcome of this program. METHODS: Data on the number of invited and examined men, screening-detected AAAs, AAAs operated on, and surgical outcome were retrieved from all 21 Swedish counties for the years 2006 through 2014. AAA-specific mortality data were retrieved from the Swedish Cause of Death Registry. A linear regression analysis was used to estimate the effect on AAA-specific mortality among all men >/=65 years of age for the observed time period. The long-term effects were projected by using a validated Markov model. RESULTS: Of 302 957 men aged 65 years invited, 84% attended. The prevalence of screening-detected AAA was 1.5%. After a mean of 4.5 years, 29% of patients with AAA had been operated on, with a 30-day mortality rate of 0.9% (1.3% after open repair and 0.3% after endovascular repair, P<0.001). The introduction of screening was associated with a significant reduction in AAA-specific mortality (mean, 4.0% per year of screening, P=0.020). The number needed to screen and the number needed to operate on to prevent 1 premature death were 667 and 1.5, respectively. With a total population of 9.5 million, the Swedish national AAA-screening program was predicted to annually prevent 90 premature deaths from AAA and to gain 577 quality-adjusted life-years. The incremental cost-efficiency ratio was estimated to be euro7770 per quality-adjusted life-years. CONCLUSIONS: Screening 65-year-old men for AAA is an effective preventive health measure and is highly cost-effective in a contemporary setting. These findings confirm the results from earlier randomized controlled trials and model studies in a large population-based setting of the importance for future healthcare decision making.", "author" : [ { "dropping-particle" : "", "family" : "Wanhainen", "given" : "A", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Hultgren", "given" : "R", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Linne", "given" : "A", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Holst", "given" : "J", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Gottsater", "given" : "A", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Langenskiold", "given" : "M", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Smidfelt", "given" : "K", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Bjorck", "given" : "M", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Svensjo", "given" : "S", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Swedish Aneurysm Screening Study", "given" : "Group", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Circulation", "id" : "ITEM-5", "issue" : "16", "issued" : { "date-parts" : [ [ "2016" ] ] }, "note" : "Wanhainen, Anders\nHultgren, Rebecka\nLinne, Anneli\nHolst, Jan\nGottsater, Anders\nLangenskiold, Marcus\nSmidfelt, Kristian\nBjorck, Martin\nSvensjo, Sverker\n(SASS)\neng\n2016/10/19 06:00\nCirculation. 2016 Oct 18;134(16):1141-1148. doi: 10.1161/CIRCULATIONAHA.116.022305. Epub 2016 Sep 14.", "page" : "1141-1148", "title" : "Outcome of the Swedish Nationwide Abdominal Aortic Aneurysm Screening Program", "type" : "article-journal", "volume" : "134" }, "uris" : [ "http://www.mendeley.com/documents/?uuid=0a65ec7f-1fdf-4c3b-9b9b-f15d93ec5108" ] } ], "mendeley" : { "formattedCitation" : "8,10,42,50,115", "plainTextFormattedCitation" : "8,10,42,50,115", "previouslyFormattedCitation" : "8,10,42,50,115" }, "properties" : { }, "schema" : "https://github.com/citation-style-language/schema/raw/master/csl-citation.json" }8,10,42,50,115 The variation could depend on risk factor distribution, such as smoking habits, but obvious differences in development of AAA exists for different ethnic groups, some groups are more prone, such as cauciansCaucasians. (ref Samson, global) There is no evidence that supports implementation of population based screening in women, mainly due to the lower prevalence and later onset of disease.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1002/bjs.8984", "ISBN" : "1365-2168 (Electronic)\r0007-1323 (Linking)", "PMID" : "23192439", "abstract" : "BACKGROUND: Screening elderly men for abdominal aortic aneurysm (AAA) to reduce mortality from rupture is evidence-based. For women epidemiological data on AAA are scarce, and the evidence for screening is insufficient. The aim of this population-based study was to determine the current prevalence of AAA and risk factors among 70-year-old women. METHODS: All 70-year-old women identified through the National Population Registry in the two neighbouring counties of Uppsala and Dalarna were invited to a free ultrasound examination of the abdominal aorta. An AAA was defined as a maximum infrarenal aortic diameter of at least 30 mm. RESULTS: Of 6925 women invited, 5140 (74.2 per cent) accepted the invitation to be screened. Among these, 19 AAAs were detected (0.4 (95 per cent confidence interval (c.i.) 0.2 to 0.5) per cent). In the invited cohort 12 women (0.2 (0.1 to 0.3) per cent) had undergone previous AAA repair (11) or had a known AAA under surveillance (1). Thus, the total prevalence was estimated at 0.5 (0.4 to 0.7) per cent. Smoking was strongly associated with AAA; 18 (95 per cent) of 19 women with a screen-detected AAA had a history of smoking compared with 44.2 per cent of those with a normal aorta (odds ratio 20.29, 95 per cent c.i. 2.70 to 152.65). The prevalence of AAA was 0.03 (0 to 0.1) per cent among never smokers, 0.4 (0.2 to 0.8) per cent among former smokers and 2.1 (1.0 to 3.7) per cent among current smokers. CONCLUSION: Screening 70-year-old women who do not smoke is likely to be futile, thus ruling out population screening of women for AAA.", "author" : [ { "dropping-particle" : "", "family" : "Svensjo", "given" : "S", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Bjorck", "given" : "M", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Wanhainen", "given" : "A", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Br J Surg", "id" : "ITEM-1", "issue" : "3", "issued" : { "date-parts" : [ [ "2013" ] ] }, "note" : "Svensjo, S\nBjorck, M\nWanhainen, A\neng\nResearch Support, Non-U.S. Gov't\nEngland\n2012/11/30 06:00\nBr J Surg. 2013 Feb;100(3):367-72. doi: 10.1002/bjs.8984. Epub 2012 Nov 28.", "page" : "367-372", "title" : "Current prevalence of abdominal aortic aneurysm in 70-year-old women", "type" : "article-journal", "volume" : "100" }, "uris" : [ "http://www.mendeley.com/documents/?uuid=3755a4ba-b759-4a88-906b-7e2c84ec12b1" ] }, { "id" : "ITEM-2", "itemData" : { "DOI" : "10.1002/bjs.10225", "ISBN" : "1365-2168 (Electronic)\r0007-1323 (Linking)", "PMID" : "27346306", "abstract" : "BACKGROUND: Although women represent an increasing proportion of those presenting with abdominal aortic aneurysm (AAA) rupture, the current prevalence of AAA in women is unknown. The contemporary population prevalence of screen-detected AAA in women was investigated by both age and smoking status. METHODS: A systematic review was undertaken of studies screening for AAA, including over 1000 women, aged at least 60 years, done since the year 2000. Studies were identified by searching MEDLINE, Embase and CENTRAL databases until 13 January 2016. Study quality was assessed using the Newcastle-Ottawa scoring system. RESULTS: Eight studies were identified, including only three based on population registers. The largest studies were based on self-purchase of screening. Altogether 1 537 633 women were screened. Overall AAA prevalence rates were very heterogeneous, ranging from 0.37 to 1.53 per cent: pooled prevalence 0.74 (95 per cent c.i. 0.53 to 1.03) per cent. The pooled prevalence increased with both age (more than 1 per cent for women aged over 70 years) and smoking (more than 1 per cent for ever smokers and over 2 per cent in current smokers). CONCLUSION: The current population prevalence of screen-detected AAA in older women is subject to wide demographic variation. However, in ever smokers and those over 70 years of age, the prevalence is over 1 per cent.", "author" : [ { "dropping-particle" : "", "family" : "Ulug", "given" : "P", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Powell", "given" : "J T", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Sweeting", "given" : "M J", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Bown", "given" : "M J", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Thompson", "given" : "S G", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Group", "given" : "Swan Collaborative", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Br J Surg", "id" : "ITEM-2", "issue" : "9", "issued" : { "date-parts" : [ [ "2016" ] ] }, "note" : "Ulug, P\nPowell, J T\nSweeting, M J\nBown, M J\nThompson, S G\neng\nHTA/14/179/01/Department of Health/United Kingdom\nMeta-Analysis\nReview\nEngland\n2016/06/28 06:00\nBr J Surg. 2016 Aug;103(9):1097-104. doi: 10.1002/bjs.10225. Epub 2016 Jun 27.", "page" : "1097-1104", "title" : "Meta-analysis of the current prevalence of screen-detected abdominal aortic aneurysm in women", "type" : "article-journal", "volume" : "103" }, "uris" : [ "http://www.mendeley.com/documents/?uuid=f13a04ba-5964-4a87-b7f6-3db2c7541b0f" ] } ], "mendeley" : { "formattedCitation" : "7,21", "plainTextFormattedCitation" : "7,21", "previouslyFormattedCitation" : "7,21" }, "properties" : { }, "schema" : "https://github.com/citation-style-language/schema/raw/master/csl-citation.json" }7,21 Targeted screening of specific risk groups [patients with subaneurysmal aorta (2.5-2.9 cm in diameter), smoking or family history] could prove to be efficient, and would also include women at risk, but the practical implementation and cost-effectiveness remain uncertain.
The cost-benefit balance of AAA screening in men, considering the predicted continued decline in prevalence, has been reevaluated in several cost-effectiveness models. If the AAA prevalence falls below 0.35-0.5%, and the incidental detection rates increase further, the programmes should be reevaluated.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1161/CIRCULATIONAHA.116.022305", "ISBN" : "1524-4539 (Electronic)\r0009-7322 (Linking)", "PMID" : "27630132", "abstract" : "BACKGROUND: A general abdominal aortic aneurysm (AAA) screening program, targeting 65-year-old men, has gradually been introduced in Sweden since 2006 and reached nationwide coverage in 2015. The aim of this study was to determine the outcome of this program. METHODS: Data on the number of invited and examined men, screening-detected AAAs, AAAs operated on, and surgical outcome were retrieved from all 21 Swedish counties for the years 2006 through 2014. AAA-specific mortality data were retrieved from the Swedish Cause of Death Registry. A linear regression analysis was used to estimate the effect on AAA-specific mortality among all men >/=65 years of age for the observed time period. The long-term effects were projected by using a validated Markov model. RESULTS: Of 302 957 men aged 65 years invited, 84% attended. The prevalence of screening-detected AAA was 1.5%. After a mean of 4.5 years, 29% of patients with AAA had been operated on, with a 30-day mortality rate of 0.9% (1.3% after open repair and 0.3% after endovascular repair, P<0.001). The introduction of screening was associated with a significant reduction in AAA-specific mortality (mean, 4.0% per year of screening, P=0.020). The number needed to screen and the number needed to operate on to prevent 1 premature death were 667 and 1.5, respectively. With a total population of 9.5 million, the Swedish national AAA-screening program was predicted to annually prevent 90 premature deaths from AAA and to gain 577 quality-adjusted life-years. The incremental cost-efficiency ratio was estimated to be euro7770 per quality-adjusted life-years. CONCLUSIONS: Screening 65-year-old men for AAA is an effective preventive health measure and is highly cost-effective in a contemporary setting. These findings confirm the results from earlier randomized controlled trials and model studies in a large population-based setting of the importance for future healthcare decision making.", "author" : [ { "dropping-particle" : "", "family" : "Wanhainen", "given" : "A", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Hultgren", "given" : "R", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Linne", "given" : "A", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Holst", "given" : "J", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Gottsater", "given" : "A", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Langenskiold", "given" : "M", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Smidfelt", "given" : "K", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Bjorck", "given" : "M", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Svensjo", "given" : "S", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Swedish Aneurysm Screening Study", "given" : "Group", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Circulation", "id" : "ITEM-1", "issue" : "16", "issued" : { "date-parts" : [ [ "2016" ] ] }, "note" : "Wanhainen, Anders\nHultgren, Rebecka\nLinne, Anneli\nHolst, Jan\nGottsater, Anders\nLangenskiold, Marcus\nSmidfelt, Kristian\nBjorck, Martin\nSvensjo, Sverker\n(SASS)\neng\n2016/10/19 06:00\nCirculation. 2016 Oct 18;134(16):1141-1148. doi: 10.1161/CIRCULATIONAHA.116.022305. Epub 2016 Sep 14.", "page" : "1141-1148", "title" : "Outcome of the Swedish Nationwide Abdominal Aortic Aneurysm Screening Program", "type" : "article-journal", "volume" : "134" }, "uris" : [ "http://www.mendeley.com/documents/?uuid=0a65ec7f-1fdf-4c3b-9b9b-f15d93ec5108" ] }, { "id" : "ITEM-2", "itemData" : { "DOI" : "10.1002/bjs.9528", "ISBN" : "1365-2168 (Electronic)\r0007-1323 (Linking)", "PMID" : "24862963", "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 pound5758 (95 per cent confidence interval pound4285 to pound7410) per life-year gained, or pound7370 ( pound5467 to pound9443) 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.", "author" : [ { "dropping-particle" : "", "family" : "Glover", "given" : "M J", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Kim", "given" : "L G", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Sweeting", "given" : "M J", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Thompson", "given" : "S G", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Buxton", "given" : "M J", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Br J Surg", "id" : "ITEM-2", "issue" : "8", "issued" : { "date-parts" : [ [ "2014" ] ] }, "note" : "Glover, M J\nKim, L G\nSweeting, M J\nThompson, S G\nBuxton, M J\neng\n08/30/02/Department of Health/United Kingdom\nMR/L003120/1/Medical Research Council/United Kingdom\nRG/08/014/24067/British Heart Foundation/United Kingdom\nResearch Support, Non-U.S. Gov't\nEngland\n2014/05/28 06:00\nBr J Surg. 2014 Jul;101(8):976-82. doi: 10.1002/bjs.9528. Epub 2014 May 27.", "page" : "976-982", "title" : "Cost-effectiveness of the National Health Service Abdominal Aortic Aneurysm Screening Programme in England", "type" : "article-journal", "volume" : "101" }, "uris" : [ "http://www.mendeley.com/documents/?uuid=d96e071d-1f88-4d6a-89b5-19bfef8895a1" ] }, { "id" : "ITEM-3", "itemData" : { "DOI" : "10.1016/j.ejvs.2013.12.023", "ISSN" : "10785884", "PMID" : "24485841", "abstract" : "OBJECTIVES The epidemiology and management of abdominal aortic aneurysms (AAA) has changed significantly, with lower prevalence, increased longevity of patients, increased use of endovascular aneurysm repair (EVAR), and improved outcome. The clinical and health economic effectiveness of one-time screening of 65-year-old men was assessed within this context. METHODS One-time ultrasound screening of 65-year-old men (invited) versus no screening (control) was analysed in a Markov model. Data on the natural course of AAA (risk of repair and rupture) was based on randomised controlled trials. Screening detected AAA prevalence (1.7%), surgical management (50% EVAR), repair outcome, costs, and long-term survival were based on contemporary population-based data. Incremental cost-efficiency ratios (ICER), absolute and relative risk reduction for death from AAA (ARR, RRR), numbers needed to screen (NNS), and life-years gained were calculated. Annual discounting was 3.5%. RESULTS In base case at 13-years follow-up the ICER was \u20ac14,706 per incremental quality-adjusted life-year (QALY); ARR was 15.1 per 10,000 invited, NNS was 530, and QALYs gained were 56.5 per 10,000 invited. RRR was 42% (from 0.36% in control to 0.21% in invited). In a lifetime analysis the ICER of screening decreased to \u20ac7,570/QALY. The parameters with highest impact on the cost-efficiency of screening in the sensitivity analysis were the prevalence of AAA (threshold value <0.5%) and degree of incidental detection in the control cohort. CONCLUSIONS In the face of recent changes in the management and epidemiology of AAA, screening men for AAA remains cost-effective and delivers significant clinical impact.", "author" : [ { "dropping-particle" : "", "family" : "Svensj\u00f6", "given" : "S.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Mani", "given" : "K.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Bj\u00f6rck", "given" : "M.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Lundkvist", "given" : "J.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Wanhainen", "given" : "A.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "European Journal of Vascular and Endovascular Surgery", "id" : "ITEM-3", "issue" : "4", "issued" : { "date-parts" : [ [ "2014", "4" ] ] }, "page" : "357-365", "title" : "Screening for Abdominal Aortic Aneurysm in 65-Year-old Men Remains Cost-effective with Contemporary Epidemiology and Management", "type" : "article-journal", "volume" : "47" }, "uris" : [ "http://www.mendeley.com/documents/?uuid=1f45883e-38df-34be-bde7-1ae242024a08" ] } ], "mendeley" : { "formattedCitation" : "115,157,158", "plainTextFormattedCitation" : "115,157,158", "previouslyFormattedCitation" : "115,157,158" }, "properties" : { }, "schema" : "https://github.com/citation-style-language/schema/raw/master/csl-citation.json" }115,157,158 A summary of the first 10 years of screening programmes in Sweden confirmed the benefit with screening of men, similar to that reported from the large randomized clinical trials of AAA screening.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1161/CIRCULATIONAHA.116.022305", "ISBN" : "1524-4539 (Electronic)\r0009-7322 (Linking)", "PMID" : "27630132", "abstract" : "BACKGROUND: A general abdominal aortic aneurysm (AAA) screening program, targeting 65-year-old men, has gradually been introduced in Sweden since 2006 and reached nationwide coverage in 2015. The aim of this study was to determine the outcome of this program. METHODS: Data on the number of invited and examined men, screening-detected AAAs, AAAs operated on, and surgical outcome were retrieved from all 21 Swedish counties for the years 2006 through 2014. AAA-specific mortality data were retrieved from the Swedish Cause of Death Registry. A linear regression analysis was used to estimate the effect on AAA-specific mortality among all men >/=65 years of age for the observed time period. The long-term effects were projected by using a validated Markov model. RESULTS: Of 302 957 men aged 65 years invited, 84% attended. The prevalence of screening-detected AAA was 1.5%. After a mean of 4.5 years, 29% of patients with AAA had been operated on, with a 30-day mortality rate of 0.9% (1.3% after open repair and 0.3% after endovascular repair, P<0.001). The introduction of screening was associated with a significant reduction in AAA-specific mortality (mean, 4.0% per year of screening, P=0.020). The number needed to screen and the number needed to operate on to prevent 1 premature death were 667 and 1.5, respectively. With a total population of 9.5 million, the Swedish national AAA-screening program was predicted to annually prevent 90 premature deaths from AAA and to gain 577 quality-adjusted life-years. The incremental cost-efficiency ratio was estimated to be euro7770 per quality-adjusted life-years. CONCLUSIONS: Screening 65-year-old men for AAA is an effective preventive health measure and is highly cost-effective in a contemporary setting. These findings confirm the results from earlier randomized controlled trials and model studies in a large population-based setting of the importance for future healthcare decision making.", "author" : [ { "dropping-particle" : "", "family" : "Wanhainen", "given" : "A", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Hultgren", "given" : "R", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Linne", "given" : "A", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Holst", "given" : "J", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Gottsater", "given" : "A", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Langenskiold", "given" : "M", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Smidfelt", "given" : "K", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Bjorck", "given" : "M", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Svensjo", "given" : "S", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Swedish Aneurysm Screening Study", "given" : "Group", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Circulation", "id" : "ITEM-1", "issue" : "16", "issued" : { "date-parts" : [ [ "2016" ] ] }, "note" : "Wanhainen, Anders\nHultgren, Rebecka\nLinne, Anneli\nHolst, Jan\nGottsater, Anders\nLangenskiold, Marcus\nSmidfelt, Kristian\nBjorck, Martin\nSvensjo, Sverker\n(SASS)\neng\n2016/10/19 06:00\nCirculation. 2016 Oct 18;134(16):1141-1148. doi: 10.1161/CIRCULATIONAHA.116.022305. Epub 2016 Sep 14.", "page" : "1141-1148", "title" : "Outcome of the Swedish Nationwide Abdominal Aortic Aneurysm Screening Program", "type" : "article-journal", "volume" : "134" }, "uris" : [ "http://www.mendeley.com/documents/?uuid=0a65ec7f-1fdf-4c3b-9b9b-f15d93ec5108" ] }, { "id" : "ITEM-2", "itemData" : { "DOI" : "10.1002/bjs.5780", "ISBN" : "0007-1323 (Print) 0007-1323 (Linking)", "PMID" : "17514666", "abstract" : "BACKGROUND: Long-term benefits of screening for abdominal aortic aneurysm (AAA) are uncertain. These are the final results of a randomized controlled screening trial for AAA in men, updating those reported previously. Benefit and compliance over a median 15-year interval were examined. METHODS: One group of men were invited for ultrasonographic AAA screening, and another group, who received standard care, acted as controls. A total of 6040 men aged 65-80 years were randomized to one of the two groups. Outcome was monitored in terms of AAA-related events (surgery or death). RESULTS: In the group invited for screening, AAA-related mortality was reduced by 11 per cent (from 1.8 to 1.6 per cent, hazard ratio 0.89) over the follow-up interval. Screening detected an AAA in 170 patients; 17 of these died from an AAA-related cause, seven of which might have been preventable. The incidence of AAA rupture after an initially normal scan increased after 10 years of follow-up, but was still low overall (0.56 per 1000 person-years). CONCLUSION: Screening with a single ultrasonography scan still conferred a benefit at 15 years, although the results were not significant for this population size. Fewer than half of the AAA-related deaths in those screened positive could be prevented. Registration number: ISRCTN 00079388 (http://www.controlled-trials.com).", "author" : [ { "dropping-particle" : "", "family" : "Ashton", "given" : "H A", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Gao", "given" : "L", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Kim", "given" : "L G", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Druce", "given" : "P S", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Thompson", "given" : "S G", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Scott", "given" : "R A", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Br J Surg", "edition" : "2007/05/22", "id" : "ITEM-2", "issue" : "6", "issued" : { "date-parts" : [ [ "2007" ] ] }, "language" : "eng", "note" : "Ashton, H A\nGao, L\nKim, L G\nDruce, P S\nThompson, S G\nScott, R A P\nMulticenter Study\nRandomized Controlled Trial\nResearch Support, Non-U.S. Gov't\nEngland\nThe British journal of surgery\nBr J Surg. 2007 Jun;94(6):696-701.", "page" : "696-701", "title" : "Fifteen-year follow-up of a randomized clinical trial of ultrasonographic screening for abdominal aortic aneurysms", "type" : "article-journal", "volume" : "94" }, "uris" : [ "http://www.mendeley.com/documents/?uuid=76e1b447-ec54-4089-83ba-952125fba15c" ] } ], "mendeley" : { "formattedCitation" : "42,115", "plainTextFormattedCitation" : "42,115", "previouslyFormattedCitation" : "42,115" }, "properties" : { }, "schema" : "https://github.com/citation-style-language/schema/raw/master/csl-citation.json" }42,115 The introduction of screening was associated with a reduction in AAA-specific mortality in men (mean: 4.0%/year of screening; P=0.020). After a mean of 4 years, 29% of patients with AAA had been operated on, with a 30-day mortality rate of 0.9%, which is comparable to 26% operated on in the MASS (Multicentre Aneurysm Screening Study) trial at 4 years.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1161/CIRCULATIONAHA.116.022305", "ISBN" : "1524-4539 (Electronic)\r0009-7322 (Linking)", "PMID" : "27630132", "abstract" : "BACKGROUND: A general abdominal aortic aneurysm (AAA) screening program, targeting 65-year-old men, has gradually been introduced in Sweden since 2006 and reached nationwide coverage in 2015. The aim of this study was to determine the outcome of this program. METHODS: Data on the number of invited and examined men, screening-detected AAAs, AAAs operated on, and surgical outcome were retrieved from all 21 Swedish counties for the years 2006 through 2014. AAA-specific mortality data were retrieved from the Swedish Cause of Death Registry. A linear regression analysis was used to estimate the effect on AAA-specific mortality among all men >/=65 years of age for the observed time period. The long-term effects were projected by using a validated Markov model. RESULTS: Of 302 957 men aged 65 years invited, 84% attended. The prevalence of screening-detected AAA was 1.5%. After a mean of 4.5 years, 29% of patients with AAA had been operated on, with a 30-day mortality rate of 0.9% (1.3% after open repair and 0.3% after endovascular repair, P<0.001). The introduction of screening was associated with a significant reduction in AAA-specific mortality (mean, 4.0% per year of screening, P=0.020). The number needed to screen and the number needed to operate on to prevent 1 premature death were 667 and 1.5, respectively. With a total population of 9.5 million, the Swedish national AAA-screening program was predicted to annually prevent 90 premature deaths from AAA and to gain 577 quality-adjusted life-years. The incremental cost-efficiency ratio was estimated to be euro7770 per quality-adjusted life-years. CONCLUSIONS: Screening 65-year-old men for AAA is an effective preventive health measure and is highly cost-effective in a contemporary setting. These findings confirm the results from earlier randomized controlled trials and model studies in a large population-based setting of the importance for future healthcare decision making.", "author" : [ { "dropping-particle" : "", "family" : "Wanhainen", "given" : "A", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Hultgren", "given" : "R", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Linne", "given" : "A", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Holst", "given" : "J", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Gottsater", "given" : "A", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Langenskiold", "given" : "M", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Smidfelt", "given" : "K", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Bjorck", "given" : "M", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Svensjo", "given" : "S", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Swedish Aneurysm Screening Study", "given" : "Group", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Circulation", "id" : "ITEM-1", "issue" : "16", "issued" : { "date-parts" : [ [ "2016" ] ] }, "note" : "Wanhainen, Anders\nHultgren, Rebecka\nLinne, Anneli\nHolst, Jan\nGottsater, Anders\nLangenskiold, Marcus\nSmidfelt, Kristian\nBjorck, Martin\nSvensjo, Sverker\n(SASS)\neng\n2016/10/19 06:00\nCirculation. 2016 Oct 18;134(16):1141-1148. doi: 10.1161/CIRCULATIONAHA.116.022305. Epub 2016 Sep 14.", "page" : "1141-1148", "title" : "Outcome of the Swedish Nationwide Abdominal Aortic Aneurysm Screening Program", "type" : "article-journal", "volume" : "134" }, "uris" : [ "http://www.mendeley.com/documents/?uuid=0a65ec7f-1fdf-4c3b-9b9b-f15d93ec5108" ] }, { "id" : "ITEM-2", "itemData" : { "DOI" : "10.1002/bjs.5780", "ISBN" : "0007-1323 (Print) 0007-1323 (Linking)", "PMID" : "17514666", "abstract" : "BACKGROUND: Long-term benefits of screening for abdominal aortic aneurysm (AAA) are uncertain. These are the final results of a randomized controlled screening trial for AAA in men, updating those reported previously. Benefit and compliance over a median 15-year interval were examined. METHODS: One group of men were invited for ultrasonographic AAA screening, and another group, who received standard care, acted as controls. A total of 6040 men aged 65-80 years were randomized to one of the two groups. Outcome was monitored in terms of AAA-related events (surgery or death). RESULTS: In the group invited for screening, AAA-related mortality was reduced by 11 per cent (from 1.8 to 1.6 per cent, hazard ratio 0.89) over the follow-up interval. Screening detected an AAA in 170 patients; 17 of these died from an AAA-related cause, seven of which might have been preventable. The incidence of AAA rupture after an initially normal scan increased after 10 years of follow-up, but was still low overall (0.56 per 1000 person-years). CONCLUSION: Screening with a single ultrasonography scan still conferred a benefit at 15 years, although the results were not significant for this population size. Fewer than half of the AAA-related deaths in those screened positive could be prevented. Registration number: ISRCTN 00079388 (http://www.controlled-trials.com).", "author" : [ { "dropping-particle" : "", "family" : "Ashton", "given" : "H A", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Gao", "given" : "L", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Kim", "given" : "L G", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Druce", "given" : "P S", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Thompson", "given" : "S G", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Scott", "given" : "R A", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Br J Surg", "edition" : "2007/05/22", "id" : "ITEM-2", "issue" : "6", "issued" : { "date-parts" : [ [ "2007" ] ] }, "language" : "eng", "note" : "Ashton, H A\nGao, L\nKim, L G\nDruce, P S\nThompson, S G\nScott, R A P\nMulticenter Study\nRandomized Controlled Trial\nResearch Support, Non-U.S. Gov't\nEngland\nThe British journal of surgery\nBr J Surg. 2007 Jun;94(6):696-701.", "page" : "696-701", "title" : "Fifteen-year follow-up of a randomized clinical trial of ultrasonographic screening for abdominal aortic aneurysms", "type" : "article-journal", "volume" : "94" }, "uris" : [ "http://www.mendeley.com/documents/?uuid=76e1b447-ec54-4089-83ba-952125fba15c" ] } ], "mendeley" : { "formattedCitation" : "42,115", "plainTextFormattedCitation" : "42,115", "previouslyFormattedCitation" : "42,115" }, "properties" : { }, "schema" : "https://github.com/citation-style-language/schema/raw/master/csl-citation.json" }42,115 Screening also decreases all-cause mortality in screened men compared to an unscreened population.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1001/jamainternmed.2016.6663", "ISBN" : "2168-6114 (Electronic)\r2168-6106 (Linking)", "PMID" : "27802490", "author" : [ { "dropping-particle" : "", "family" : "Lederle", "given" : "F A", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "JAMA Intern Med", "id" : "ITEM-1", "issue" : "12", "issued" : { "date-parts" : [ [ "2016" ] ] }, "note" : "Lederle, Frank A\neng\n2016/11/02 06:00\nJAMA Intern Med. 2016 Dec 1;176(12):1767-1768. doi: 10.1001/jamainternmed.2016.6663.", "page" : "1767-1768", "title" : "The Last (Randomized) Word on Screening for Abdominal Aortic Aneurysms", "type" : "article-journal", "volume" : "176" }, "uris" : [ "http://www.mendeley.com/documents/?uuid=d6a6f5ca-b7b7-4217-9625-c58068ff4ad0" ] } ], "mendeley" : { "formattedCitation" : "159", "plainTextFormattedCitation" : "159", "previouslyFormattedCitation" : "159" }, "properties" : { }, "schema" : "https://github.com/citation-style-language/schema/raw/master/csl-citation.json" }159
[H1] Management
The annual number of treated patients, as well as the distribution between intervention for rupture and intact AAA varies between regions and countries, and the screening activity in the population will influence the proportion of elective repair. The intervention rate is much higher in the USA as compared to the UK or Sweden (64/100000 vs 32-42/100000) probably reflecting the fee-for-service health care system in the USA, rather than general governmental reimbursement systems commonly used in Europe.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1056/NEJMoa1600931", "ISBN" : "1533-4406 (Electronic)\r0028-4793 (Linking)", "PMID" : "27959727", "abstract" : "BACKGROUND: Thresholds for repair of abdominal aortic aneurysms vary considerably among countries. METHODS: We examined differences between England and the United States in the frequency of aneurysm repair, the mean aneurysm diameter at the time of the procedure, and rates of aneurysm rupture and aneurysm-related death. Data on the frequency of repair of intact (nonruptured) abdominal aortic aneurysms, in-hospital mortality among patients who had undergone aneurysm repair, and rates of aneurysm rupture during the period from 2005 through 2012 were extracted from the Hospital Episode Statistics database in England and the U.S. Nationwide Inpatient Sample. Data on the aneurysm diameter at the time of repair were extracted from the U.K. National Vascular Registry (2014 data) and from the U.S. National Surgical Quality Improvement Program (2013 data). Aneurysm-related mortality during the period from 2005 through 2012 was determined from data obtained from the Centers for Disease Control and Prevention and the U.K. Office of National Statistics. Data were adjusted with the use of direct standardization or conditional logistic regression for differences between England and the United States with respect to population age and sex. RESULTS: During the period from 2005 through 2012, a total of 29,300 patients in England and 278,921 patients in the United States underwent repair of intact abdominal aortic aneurysms. Aneurysm repair was less common in England than in the United States (odds ratio, 0.49; 95% confidence interval [CI], 0.48 to 0.49; P<0.001), and aneurysm-related death was more common in England than in the United States (odds ratio, 3.60; 95% CI, 3.55 to 3.64; P<0.001). Hospitalization due to an aneurysm rupture occurred more frequently in England than in the United States (odds ratio, 2.23; 95% CI, 2.19 to 2.27; P<0.001), and the mean aneurysm diameter at the time of repair was larger in England (63.7 mm vs. 58.3 mm, P<0.001). CONCLUSIONS: We found a lower rate of repair of abdominal aortic aneurysms and a larger mean aneurysm diameter at the time of repair in England than in the United States and lower rates of aneurysm rupture and aneurysm-related death in the United States than in England. (Funded by the Circulation Foundation and others.).", "author" : [ { "dropping-particle" : "", "family" : "Karthikesalingam", "given" : "A", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Vidal-Diez", "given" : "A", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Holt", "given" : "P J", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Loftus", "given" : "I M", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Schermerhorn", "given" : "M L", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Soden", "given" : "P A", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Landon", "given" : "B E", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Thompson", "given" : "M M", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "N Engl J Med", "id" : "ITEM-1", "issue" : "21", "issued" : { "date-parts" : [ [ "2016" ] ] }, "note" : "Karthikesalingam, Alan\nVidal-Diez, Alberto\nHolt, Peter J\nLoftus, Ian M\nSchermerhorn, Marc L\nSoden, Peter A\nLandon, Bruce E\nThompson, Matthew M\neng\nNIHR-CS-011-008/Department of Health/United Kingdom\nPG/13/98/30490/British Heart Foundation/United Kingdom\nR01 HL105453/HL/NHLBI NIH HHS/\nT32 HL007734/HL/NHLBI NIH HHS/\nComparative Study\n2016/12/14 06:00\nN Engl J Med. 2016 Nov 24;375(21):2051-2059. doi: 10.1056/NEJMoa1600931.", "page" : "2051-2059", "title" : "Thresholds for Abdominal Aortic Aneurysm Repair in England and the United States", "type" : "article-journal", "volume" : "375" }, "uris" : [ "http://www.mendeley.com/documents/?uuid=6ded07c1-4a45-46b8-b52c-9dfeb3b13bf9" ] }, { "id" : "ITEM-2", "itemData" : { "author" : [ { "dropping-particle" : "", "family" : "Nordanstig", "given" : "J", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "id" : "ITEM-2", "issued" : { "date-parts" : [ [ "2015" ] ] }, "title" : "The Swedvasc Annual Report 2014", "type" : "report" }, "uris" : [ "http://www.mendeley.com/documents/?uuid=1df972d7-9850-4102-9e7c-d7639612e994" ] } ], "mendeley" : { "formattedCitation" : "51,52", "plainTextFormattedCitation" : "51,52", "previouslyFormattedCitation" : "51,52" }, "properties" : { }, "schema" : "https://github.com/citation-style-language/schema/raw/master/csl-citation.json" }51,52 The mean aortic diameter in treated patients is also a marker that reflects the diversity in treatment regimes. There is a trend towards an increasing proportion of patients being treated at smaller diameters in many countries, especially within fee-for-service systems.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1056/NEJMoa1600931", "ISBN" : "1533-4406 (Electronic)\r0028-4793 (Linking)", "PMID" : "27959727", "abstract" : "BACKGROUND: Thresholds for repair of abdominal aortic aneurysms vary considerably among countries. METHODS: We examined differences between England and the United States in the frequency of aneurysm repair, the mean aneurysm diameter at the time of the procedure, and rates of aneurysm rupture and aneurysm-related death. Data on the frequency of repair of intact (nonruptured) abdominal aortic aneurysms, in-hospital mortality among patients who had undergone aneurysm repair, and rates of aneurysm rupture during the period from 2005 through 2012 were extracted from the Hospital Episode Statistics database in England and the U.S. Nationwide Inpatient Sample. Data on the aneurysm diameter at the time of repair were extracted from the U.K. National Vascular Registry (2014 data) and from the U.S. National Surgical Quality Improvement Program (2013 data). Aneurysm-related mortality during the period from 2005 through 2012 was determined from data obtained from the Centers for Disease Control and Prevention and the U.K. Office of National Statistics. Data were adjusted with the use of direct standardization or conditional logistic regression for differences between England and the United States with respect to population age and sex. RESULTS: During the period from 2005 through 2012, a total of 29,300 patients in England and 278,921 patients in the United States underwent repair of intact abdominal aortic aneurysms. Aneurysm repair was less common in England than in the United States (odds ratio, 0.49; 95% confidence interval [CI], 0.48 to 0.49; P<0.001), and aneurysm-related death was more common in England than in the United States (odds ratio, 3.60; 95% CI, 3.55 to 3.64; P<0.001). Hospitalization due to an aneurysm rupture occurred more frequently in England than in the United States (odds ratio, 2.23; 95% CI, 2.19 to 2.27; P<0.001), and the mean aneurysm diameter at the time of repair was larger in England (63.7 mm vs. 58.3 mm, P<0.001). CONCLUSIONS: We found a lower rate of repair of abdominal aortic aneurysms and a larger mean aneurysm diameter at the time of repair in England than in the United States and lower rates of aneurysm rupture and aneurysm-related death in the United States than in England. (Funded by the Circulation Foundation and others.).", "author" : [ { "dropping-particle" : "", "family" : "Karthikesalingam", "given" : "A", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Vidal-Diez", "given" : "A", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Holt", "given" : "P J", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Loftus", "given" : "I M", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Schermerhorn", "given" : "M L", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Soden", "given" : "P A", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Landon", "given" : "B E", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Thompson", "given" : "M M", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "N Engl J Med", "id" : "ITEM-1", "issue" : "21", "issued" : { "date-parts" : [ [ "2016" ] ] }, "note" : "Karthikesalingam, Alan\nVidal-Diez, Alberto\nHolt, Peter J\nLoftus, Ian M\nSchermerhorn, Marc L\nSoden, Peter A\nLandon, Bruce E\nThompson, Matthew M\neng\nNIHR-CS-011-008/Department of Health/United Kingdom\nPG/13/98/30490/British Heart Foundation/United Kingdom\nR01 HL105453/HL/NHLBI NIH HHS/\nT32 HL007734/HL/NHLBI NIH HHS/\nComparative Study\n2016/12/14 06:00\nN Engl J Med. 2016 Nov 24;375(21):2051-2059. doi: 10.1056/NEJMoa1600931.", "page" : "2051-2059", "title" : "Thresholds for Abdominal Aortic Aneurysm Repair in England and the United States", "type" : "article-journal", "volume" : "375" }, "uris" : [ "http://www.mendeley.com/documents/?uuid=6ded07c1-4a45-46b8-b52c-9dfeb3b13bf9" ] }, { "id" : "ITEM-2", "itemData" : { "author" : [ { "dropping-particle" : "", "family" : "Nordanstig", "given" : "J", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "id" : "ITEM-2", "issued" : { "date-parts" : [ [ "2015" ] ] }, "title" : "The Swedvasc Annual Report 2014", "type" : "report" }, "uris" : [ "http://www.mendeley.com/documents/?uuid=1df972d7-9850-4102-9e7c-d7639612e994" ] }, { "id" : "ITEM-3", "itemData" : { "DOI" : "10.1161/CIRCULATIONAHA.116.024870", "ISBN" : "1524-4539 (Electronic)\r0009-7322 (Linking)", "PMID" : "27784712", "abstract" : "BACKGROUND: This project by the ICVR (International Consortium of Vascular Registries), a collaboration of 11 vascular surgical quality registries, was designed to evaluate international variation in the contemporary management of abdominal aortic aneurysm (AAA) with relation to recommended treatment guidelines from the Society for Vascular Surgery and the European Society for Vascular Surgery. METHODS: Registry data for open and endovascular AAA repair (EVAR) during 2010 to 2013 were collected from 11 countries. Variations in patient selection and treatment were compared across countries and across centers within countries. RESULTS: Among 51 153 patients, 86% were treated for intact AAA (iAAA) and 14% for ruptured AAA. Women constituted 18% of the entire cohort (range, 12% in Switzerland-21% in the United States; P<0.01). Intact AAAs were repaired at diameters smaller than recommended by guidelines in 31% of men (<5.5 cm; range, 6% in Iceland-41% in Germany; P<0.01) and 12% of women with iAAA (<5 cm; range, 0% in Iceland-16% in the United States; P<0.01). Overall, use of EVAR for iAAA varied from 28% in Hungary to 79% in the United States (P<0.01) and for ruptured AAA from 5% in Denmark to 52% in the United States (P<0.01). In addition to the between-country variations, significant variations were present between centers in each country in terms of EVAR use and rate of small AAA repair. Countries that more frequently treated small AAAs tended to use EVAR more frequently (trend: correlation coefficient, 0.51; P=0.14). Octogenarians made up 23% of all patients, ranging from 12% in Hungary to 29% in Australia (P<0.01). In countries with a fee-for-service reimbursement system (Australia, Germany, Switzerland, and the United States), the proportions of small AAA (33%) and octogenarians undergoing iAAA repair (25%) were higher compared with countries with a population-based reimbursement model (small AAA repair, 16%; octogenarians, 18%; P<0.01). In general, center-level variation within countries in the management of AAA was as important as variation between countries. CONCLUSIONS: Despite homogeneous guidelines from professional societies, significant variation exists in the management of AAA, most notably for iAAA diameter at repair, use of EVAR, and the treatment of elderly patients. ICVR provides an opportunity to study treatment variation across countries and to encourage optimal practice by sharing these results.", "author" : [ { "dropping-particle" : "", "family" : "Beck", "given" : "A W", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Sedrakyan", "given" : "A", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Mao", "given" : "J", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Venermo", "given" : "M", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Faizer", "given" : "R", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Debus", "given" : "S", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Behrendt", "given" : "C A", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Scali", "given" : "S", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Altreuther", "given" : "M", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Schermerhorn", "given" : "M", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Beiles", "given" : "B", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Szeberin", "given" : "Z", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Eldrup", "given" : "N", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Danielsson", "given" : "G", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Thomson", "given" : "I", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Wigger", "given" : "P", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Bjorck", "given" : "M", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Cronenwett", "given" : "J L", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Mani", "given" : "K", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "International Consortium of Vascular", "given" : "Registries", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Circulation", "id" : "ITEM-3", "issue" : "24", "issued" : { "date-parts" : [ [ "2016" ] ] }, "note" : "Beck, Adam W\nSedrakyan, Art\nMao, Jialin\nVenermo, Maarit\nFaizer, Rumi\nDebus, Sebastian\nBehrendt, Christian-Alexander\nScali, Salvatore\nAltreuther, Martin\nSchermerhorn, Marc\nBeiles, Barry\nSzeberin, Zoltan\nEldrup, Nikolaj\nDanielsson, Gudmundur\nThomson, Ian\nWigger, Pius\nBjorck, Martin\nCronenwett, Jack L\nMani, Kevin\neng\nK23 HL115673/HL/NHLBI NIH HHS/\nU01 FD004939/FD/FDA HHS/\nMulticenter Study\n2016/10/28 06:00\nCirculation. 2016 Dec 13;134(24):1948-1958. doi: 10.1161/CIRCULATIONAHA.116.024870. Epub 2016 Oct 26.", "page" : "1948-1958", "title" : "Variations in Abdominal Aortic Aneurysm Care: A Report From the International Consortium of Vascular Registries", "type" : "article-journal", "volume" : "134" }, "uris" : [ "http://www.mendeley.com/documents/?uuid=06d2985a-4884-4db5-beb1-e22e6cbe4100" ] } ], "mendeley" : { "formattedCitation" : "51\u201353", "plainTextFormattedCitation" : "51\u201353", "previouslyFormattedCitation" : "51\u201353" }, "properties" : { }, "schema" : "https://github.com/citation-style-language/schema/raw/master/csl-citation.json" }5153 In most modern vascular services, 75-85% of AAA repairs are performed electively for intact aneurysms.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "author" : [ { "dropping-particle" : "", "family" : "Nordanstig", "given" : "J", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "id" : "ITEM-1", "issued" : { "date-parts" : [ [ "2015" ] ] }, "title" : "The Swedvasc Annual Report 2014", "type" : "report" }, "uris" : [ "http://www.mendeley.com/documents/?uuid=1df972d7-9850-4102-9e7c-d7639612e994" ] }, { "id" : "ITEM-2", "itemData" : { "DOI" : "10.1002/bjs.9759", "ISBN" : "1365-2168 (Electronic)\r0007-1323 (Linking)", "PMID" : "25703735", "abstract" : "BACKGROUND: There is significant variation in the mortality rates of patients with a ruptured abdominal aortic aneurysm (rAAA) admitted to hospital in England. This study sought to investigate whether modifiable differences in hospital structures and processes were associated with differences in patient outcome. METHODS: Patients diagnosed with rAAA between 2005 and 2010 were extracted from the Hospital Episode Statistics database. After risk adjustment, hospitals were grouped into low-mortality outlier, expected mortality and high-mortality outlier categories. Hospital Trust-level structure and process variables were compared between categories, and tested for an association with risk-adjusted 90-day mortality and non-corrective treatment (palliation) rate using binary logistic regression models. RESULTS: There were 9877 patients admitted to 153 English NHS Trusts with an rAAA during the study. The overall combined (operative and non-operative) mortality rate was 67.5 per cent (palliation rate 41.6 per cent). Seven hospital Trusts (4.6 per cent) were high-mortality and 15 (9.8 per cent) were low-mortality outliers. Low-mortality outliers used significantly greater mean resources per bed (doctors: 0.922 versus 0.513, P < 0.001; consultant doctors: 0.316 versus 0.168, P < 0.001; nurses: 2.341 versus 1.770, P < 0.001; critical care beds: 0.045 versus 0.019, P < 0.001; operating theatres: 0.027 versus 0.019, P = 0.002) and performed more fluoroscopies (mean 12.6 versus 9.2 per bed; P = 0.046) than high-mortality outlier hospital Trusts. On multivariable analysis, greater numbers of consultants, nurses and fluoroscopies, teaching status, weekday admission and rAAA volume were independent predictors of lower mortality and, excluding rAAA volume, a lower rate of palliation. CONCLUSION: The variability in rAAA outcome in English National Health Service hospital Trusts is associated with modifiable hospital resources. Such information should be used to inform any proposed quality improvement programme surrounding rAAA.", "author" : [ { "dropping-particle" : "", "family" : "Ozdemir", "given" : "B A", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Karthikesalingam", "given" : "A", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Sinha", "given" : "S", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Poloniecki", "given" : "J D", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Vidal-Diez", "given" : "A", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Hinchliffe", "given" : "R J", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Thompson", "given" : "M M", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Holt", "given" : "P J", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Br J Surg", "id" : "ITEM-2", "issue" : "5", "issued" : { "date-parts" : [ [ "2015" ] ] }, "note" : "Ozdemir, B A\nKarthikesalingam, A\nSinha, S\nPoloniecki, J D\nVidal-Diez, A\nHinchliffe, R J\nThompson, M M\nHolt, P J E\neng\nNIHR-CS-011-008/Department of Health/United Kingdom\nResearch Support, Non-U.S. Gov't\nEngland\n2015/02/24 06:00\nBr J Surg. 2015 Apr;102(5):516-24. doi: 10.1002/bjs.9759. Epub 2015 Feb 19.", "page" : "516-524", "title" : "Association of hospital structures with mortality from ruptured abdominal aortic aneurysm", "type" : "article-journal", "volume" : "102" }, "uris" : [ "http://www.mendeley.com/documents/?uuid=02c9ee98-2544-40df-8faf-e57f4502d590" ] } ], "mendeley" : { "formattedCitation" : "52,54", "plainTextFormattedCitation" : "52,54", "previouslyFormattedCitation" : "52,54" }, "properties" : { }, "schema" : "https://github.com/citation-style-language/schema/raw/master/csl-citation.json" }52,54
Patients with an asymptomatic fusiform AAA of >5.4cm in diameter should be considered for elective repair, while surveillance is recommended for smaller AAA. Elective repair is also recommended for patients who present with a saccular aneurysm generally at smaller diameter, although specific guidelines for saccular AAA are lacking due to their infrequent presentation. For patients with rapid expansion of a small fusiform AAA an earlier repair might be considered. Moreover, young and healthy patients, and particularly women, with an AAA 5.0 - 5.4 cm may benefit from early repair. However patients with an AAA >5.4 cm, but with advanced age or significant comorbidities and risk factors repair may be delayed. (J Vasc Surg. 2018 Jan;67(1):2-77.e2. Surgery practice guidelines
In contrast to intact asymptomatic AAA, a ruptured AAA is a surgical emergency and immediate treatment is required. Patients that present with a symptomatic, but not-ruptured AAA also require prompt treatment. Contemporary management of patients with ruptured AAA can also be either by EVAR or open repair. Recent trial results suggest that short and long-term results are better with EVAR. (ref IMPROVE THREE YEAR RESULTS).
A delayed intervention for several hours might be considered in selected occasions to optimise conditions for successful repair (e.g. optimal anesthetic support, available blood products, appropriate device etc.). If a delayed treatment is chosen, close monitoring in an Intensive care unit is recommended
Open Surgery
Open surgery is usually performed via a transperitoneal approach with midline laparotomy. Alternatively, a left retroperitoneal approach can be used. Aortic cross clamping should be performed below the renal arteries if possible. If the AAA extends above the renal arteries a supraceliac clamping may be preferred, increasing rates of renal dysfunction and perioperative morbidity.
Open AAA repair continues to be used for patients that are not anatomically suitable for EVAR, (e,g, short sealing zones, multiple accessory renal arteries, not suitable access vessels etc.) and in countries with limited resources for healthcare.
Open repair may also be offered to young and healthy individuals despite suitability for EVAR, given the probably better long-term durability and the reduced need for long-term surveillance and reinterventions compared to EVAR. Open surgery may also be required for treatment of complications after EVAR (e.g. persistent endoleak, aneurysm sac growth) or for treatment of a mycotic AAA or graft infection. ((J Vasc Surg. 2018 Jan;67(1):2-77.e2. doi: 10.1016/j.jvs.2017.10.044. The Society for Vascular Surgery practice guidelines on the care of patients with an abdominal aortic aneurysm. Chaikof EL1, Dalman RL2, Eskandari MK3, Jackson BM4, Lee WA5, Mansour MA6, Mastracci TM7, Mell M2, Murad MH8, Nguyen LL9, Oderich GS10, Patel MS11, Schermerhorn ML12, Starnes BW13. )
[H2] Endovascular treatment
Endovascular aneurysm repair (EVAR) refers to implantation of a bifurcated stent-graft via the femoral and iliac arteries with the aim to exclude the AAA from the systemic circulation. In order to introduce the stent-graft access vessels should be of adequate quality. Furthermore to achieve complete sealing, healthy (non-aneurysmal) proximal and distal zones are required for landing of the stent-graft. In cases of inadequate proximal landing zone below the renal arteries, the suprarenal part of the aorta can be used for sealing using advanced endovascular techniques such as fenestrated grafts (stent-grafts with fenestrations-holes to accommodate the renal arteries and the superior mesenteric artery and celiac trunk if needed.) Alternatively, the chimney technique can be used referring to placement of stent-grafts (chimneys) parallel to the main aortic stent-graft aiming to maintain perfusion of the renal arteries. (Figure 9)
During its early phase, EVAR was considered only for frail patients unfit for open surgery. Gradually, the indications expanded to include also low-risk patients. Nowadays EVAR is considered a safe alternative for anatomically suitable AAAs and is actually the preferred approach in most centres (FIG. 10).ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1038/nrcardio.2013.196", "ISBN" : "1759-5010 (Electronic)\r1759-5002 (Linking)", "PMID" : "24343568", "abstract" : "Patients with abdominal aortic aneurysms (AAAs) are usually treated with endovascular aneurysm repair (EVAR), which has become the standard of care in many hospitals for patients with suitable anatomy. Clinical evidence indicates that EVAR is associated with superior perioperative outcomes and similar long-term survival compared with open repair. Since the randomized, controlled trials that provided this evidence were conducted, however, the stent graft technology for infrarenal AAA has been further developed. Improvements include profile downsizing, optimization of sealing and fixation, and the use of low porosity fabrics. In addition, imaging techniques have improved, enabling better preoperative planning, stent graft placement, and postoperative surveillance. Also in the past few years, fenestrated and branched stent grafts have increasingly been used to manage anatomically challenging aneurysms, and experiments with off-label use of stent grafts have been performed to treat patients deemed unfit or unsuitable for other treatment strategies. Overall, the indications for endovascular management of AAA are expanding to include increasingly complex and anatomically challenging aneurysms. Ongoing studies and optimization of imaging, in addition to technological refinement of stent grafts, will hopefully continue to broaden the utilization of EVAR.", "author" : [ { "dropping-particle" : "", "family" : "Buck", "given" : "D B", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Herwaarden", "given" : "J A", "non-dropping-particle" : "van", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Schermerhorn", "given" : "M L", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Moll", "given" : "F L", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Nat Rev Cardiol", "id" : "ITEM-1", "issue" : "2", "issued" : { "date-parts" : [ [ "2014" ] ] }, "note" : "Buck, Dominique B\nvan Herwaarden, Joost A\nSchermerhorn, Marc L\nMoll, Frans L\neng\nR01 HL105453/HL/NHLBI NIH HHS/\nT32 HL007734/HL/NHLBI NIH HHS/\nResearch Support, N.I.H., Extramural\nReview\nEngland\n2013/12/18 06:00\nNat Rev Cardiol. 2014 Feb;11(2):112-23. doi: 10.1038/nrcardio.2013.196. Epub 2013 Dec 17.", "page" : "112-123", "title" : "Endovascular treatment of abdominal aortic aneurysms", "type" : "article-journal", "volume" : "11" }, "uris" : [ "http://www.mendeley.com/documents/?uuid=5ec02459-ceb2-483b-aaae-f13b822ca87e" ] } ], "mendeley" : { "formattedCitation" : "166", "plainTextFormattedCitation" : "166", "previouslyFormattedCitation" : "166" }, "properties" : { }, "schema" : "https://github.com/citation-style-language/schema/raw/master/csl-citation.json" }166
Several randomized and observational studies have compared EVAR with open AAA repair.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1056/NEJMoa042002", "ISBN" : "1533-4406 (Electronic)\r0028-4793 (Linking)", "PMID" : "15483279", "abstract" : "BACKGROUND: Although the initial results of endovascular repair of abdominal aortic aneurysms were promising, current evidence from controlled studies does not convincingly show a reduction in 30-day mortality relative to that achieved with open repair. METHODS: We conducted a multicenter, randomized trial comparing open repair with endovascular repair in 345 patients who had received a diagnosis of abdominal aortic aneurysm of at least 5 cm in diameter and who were considered suitable candidates for both techniques. The outcome events analyzed were operative (30-day) mortality and two composite end points of operative mortality and severe complications and operative mortality and moderate or severe complications. RESULTS: The operative mortality rate was 4.6 percent in the open-repair group (8 of 174 patients; 95 percent confidence interval, 2.0 to 8.9 percent) and 1.2 percent in the endovascular-repair group (2 of 171 patients; 95 percent confidence interval, 0.1 to 4.2 percent), resulting in a risk ratio of 3.9 (95 percent confidence interval, 0.9 to 32.9). The combined rate of operative mortality and severe complications was 9.8 percent in the open-repair group (17 of 174 patients; 95 percent confidence interval, 5.8 to 15.2 percent) and 4.7 percent in the endovascular-repair group (8 of 171 patients; 95 percent confidence interval, 2.0 to 9.0 percent), resulting in a risk ratio of 2.1 (95 percent confidence interval, 0.9 to 5.4). CONCLUSIONS: On the basis of the overall results of this trial, endovascular repair is preferable to open repair in patients who have an abdominal aortic aneurysm that is at least 5 cm in diameter. Long-term follow-up is needed to determine whether this advantage is sustained.", "author" : [ { "dropping-particle" : "", "family" : "Prinssen", "given" : "M", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Verhoeven", "given" : "E L", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Buth", "given" : "J", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Cuypers", "given" : "P W", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Sambeek", "given" : "M R", "non-dropping-particle" : "van", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Balm", "given" : "R", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Buskens", "given" : "E", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Grobbee", "given" : "D E", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Blankensteijn", "given" : "J D", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Dutch Randomized Endovascular Aneurysm Management Trial", "given" : "Group", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "N Engl J Med", "id" : "ITEM-1", "issue" : "16", "issued" : { "date-parts" : [ [ "2004" ] ] }, "note" : "Prinssen, Monique\nVerhoeven, Eric L G\nButh, Jaap\nCuypers, Philippe W M\nvan Sambeek, Marc R H M\nBalm, Ron\nBuskens, Erik\nGrobbee, Diederick E\nBlankensteijn, Jan D\n(DREAM)\neng\nClinical Trial\nComparative Study\nMulticenter Study\nRandomized Controlled Trial\nResearch Support, Non-U.S. Gov't\n2004/10/16 09:00\nN Engl J Med. 2004 Oct 14;351(16):1607-18. doi: 10.1056/NEJMoa042002.", "page" : "1607-1618", "title" : "A randomized trial comparing conventional and endovascular repair of abdominal aortic aneurysms", "type" : "article-journal", "volume" : "351" }, "uris" : [ "http://www.mendeley.com/documents/?uuid=42fa4826-7adf-41ad-8439-53d4891ca0d1" ] }, { "id" : "ITEM-2", "itemData" : { "DOI" : "10.1056/NEJMoa051255", "ISBN" : "1533-4406 (Electronic)\r0028-4793 (Linking)", "PMID" : "15944424", "abstract" : "BACKGROUND: Two randomized trials have shown better outcomes with elective endovascular repair of abdominal aortic aneurysms than with conventional open repair in the first month after the procedure. We investigated whether this advantage is sustained beyond the perioperative period. METHODS: We conducted a multicenter, randomized trial comparing open repair with endovascular repair in 351 patients who had received a diagnosis of abdominal aortic aneurysm of at least 5 cm in diameter and who were considered suitable candidates for both techniques. Survival after randomization was calculated with the use of Kaplan-Meier analysis and compared with the use of the log-rank test on an intention-to-treat-basis. RESULTS: Two years after randomization, the cumulative survival rates were 89.6 percent for open repair and 89.7 percent for endovascular repair (difference, -0.1 percentage point; 95 percent confidence interval, -6.8 to 6.7 percentage points). The cumulative rates of aneurysm-related death were 5.7 percent for open repair and 2.1 percent for endovascular repair (difference, 3.7 percentage points; 95 percent confidence interval, -0.5 to 7.9 percentage points). This advantage of endovascular repair over open repair was entirely accounted for by events occurring in the perioperative period, with no significant difference in subsequent aneurysm-related mortality. The rate of survival free of moderate or severe complications was also similar in the two groups at two years (at 65.9 percent for open repair and 65.6 percent for endovascular repair; difference, 0.3 percentage point; 95 percent confidence interval, -10.0 to 10.6 percentage points). CONCLUSIONS: The perioperative survival advantage with endovascular repair as compared with open repair is not sustained after the first postoperative year.", "author" : [ { "dropping-particle" : "", "family" : "Blankensteijn", "given" : "J D", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Jong", "given" : "S E", "non-dropping-particle" : "de", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Prinssen", "given" : "M", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Ham", "given" : "A C", "non-dropping-particle" : "van der", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Buth", "given" : "J", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Sterkenburg", "given" : "S M", "non-dropping-particle" : "van", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Verhagen", "given" : "H J", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Buskens", "given" : "E", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Grobbee", "given" : "D E", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Dutch Randomized Endovascular Aneurysm Management Trial", "given" : "Group", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "N Engl J Med", "id" : "ITEM-2", "issue" : "23", "issued" : { "date-parts" : [ [ "2005" ] ] }, "note" : "Blankensteijn, Jan D\nde Jong, Sjors E C A\nPrinssen, Monique\nvan der Ham, Arie C\nButh, Jaap\nvan Sterkenburg, Steven M M\nVerhagen, Hence J M\nBuskens, Erik\nGrobbee, Diederick E\n(DREAM)\neng\nClinical Trial\nComparative Study\nMulticenter Study\nRandomized Controlled Trial\nResearch Support, Non-U.S. Gov't\n2005/06/10 09:00\nN Engl J Med. 2005 Jun 9;352(23):2398-405. doi: 10.1056/NEJMoa051255.", "page" : "2398-2405", "title" : "Two-year outcomes after conventional or endovascular repair of abdominal aortic aneurysms", "type" : "article-journal", "volume" : "352" }, "uris" : [ "http://www.mendeley.com/documents/?uuid=66e3725e-a437-4e74-b7fe-78b59fe876c5" ] }, { "id" : "ITEM-3", "itemData" : { "DOI" : "10.1056/NEJMoa0909499", "ISBN" : "1533-4406 (Electronic)\r0028-4793 (Linking)", "PMID" : "20484396", "abstract" : "BACKGROUND: For patients with large abdominal aortic aneurysms, randomized trials have shown an initial overall survival benefit for elective endovascular repair over conventional open repair. This survival difference, however, was no longer significant in the second year after the procedure. Information regarding the comparative outcome more than 2 years after surgery is important for clinical decision making. METHODS: We conducted a long-term, multicenter, randomized, controlled trial comparing open repair with endovascular repair in 351 patients with an abdominal aortic aneurysm of at least 5 cm in diameter who were considered suitable candidates for both techniques. The primary outcomes were rates of death from any cause and reintervention. Survival was calculated with the use of Kaplan-Meier methods on an intention-to-treat basis. RESULTS: We randomly assigned 178 patients to undergo open repair and 173 to undergo endovascular repair. Six years after randomization, the cumulative survival rates were 69.9% for open repair and 68.9% for endovascular repair (difference, 1.0 percentage point; 95% confidence interval [CI], -8.8 to 10.8; P=0.97). The cumulative rates of freedom from secondary interventions were 81.9% for open repair and 70.4% for endovascular repair (difference, 11.5 percentage points; 95% CI, 2.0 to 21.0; P=0.03). CONCLUSIONS: Six years after randomization, endovascular and open repair of abdominal aortic aneurysm resulted in similar rates of survival. The rate of secondary interventions was significantly higher for endovascular repair. (ClinicalTrials.gov number, NCT00421330.)", "author" : [ { "dropping-particle" : "", "family" : "Bruin", "given" : "J L", "non-dropping-particle" : "De", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Baas", "given" : "A F", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Buth", "given" : "J", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Prinssen", "given" : "M", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Verhoeven", "given" : "E L", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Cuypers", "given" : "P W", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Sambeek", "given" : "M R", "non-dropping-particle" : "van", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Balm", "given" : "R", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Grobbee", "given" : "D E", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Blankensteijn", "given" : "J D", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Group", "given" : "Dream Study", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "N Engl J Med", "id" : "ITEM-3", "issue" : "20", "issued" : { "date-parts" : [ [ "2010" ] ] }, "note" : "De Bruin, Jorg L\nBaas, Annette F\nButh, Jaap\nPrinssen, Monique\nVerhoeven, Eric L G\nCuypers, Philippe W M\nvan Sambeek, Marc R H M\nBalm, Ron\nGrobbee, Diederick E\nBlankensteijn, Jan D\neng\nComparative Study\nMulticenter Study\nRandomized Controlled Trial\nResearch Support, Non-U.S. Gov't\n2010/05/21 06:00\nN Engl J Med. 2010 May 20;362(20):1881-9. doi: 10.1056/NEJMoa0909499.", "page" : "1881-1889", "title" : "Long-term outcome of open or endovascular repair of abdominal aortic aneurysm", "type" : "article-journal", "volume" : "362" }, "uris" : [ "http://www.mendeley.com/documents/?uuid=ccd90be1-cd78-433a-814a-c7298954aba1" ] }, { "id" : "ITEM-4", "itemData" : { "DOI" : "10.1016/S0140-6736(04)16979-1", "ISBN" : "1474-547X (Electronic)\r0140-6736 (Linking)", "PMID" : "15351191", "abstract" : "BACKGROUND: Endovascular aneurysm repair (EVAR) is a new technology to treat patients with abdominal aortic aneurysm (AAA) when the anatomy is suitable. Uncertainty exists about how endovascular repair compares with conventional open surgery. EVAR trial 1 was instigated to compare these treatments in patients judged fit for open AAA repair. METHODS: Between 1999 and 2003, 1082 elective (non-emergency) patients were randomised to receive either EVAR (n=543) or open AAA repair (n=539). Patients aged at least 60 years with aneurysms of diameter 5.5 cm or more, who were fit enough for open surgical repair (anaesthetically and medically well enough for the procedure), were recruited for the study at 41 British hospitals proficient in the EVAR technique. The primary outcome measure is all-cause mortality and these results will be released in 2005. The primary analysis presented here is operative mortality by intention to treat and a secondary analysis was done in per-protocol patients. FINDINGS: Patients (983 men, 99 women) had a mean age of 74 years (SD 6) and mean AAA diameter of 6.5 cm (SD 1). 1047 (97%) patients underwent AAA repair and 1008 (93%) received their allocated treatment. 30-day mortality in the EVAR group was 1.7% (9/531) versus 4.7% (24/516) in the open repair group (odds ratio 0.35 [95% CI 0.16-0.77], p=0.009). By per-protocol analysis, 30-day mortality for EVAR was 1.6% (8/512) versus 4.6% (23/496) for open repair (0.33 [0.15-0.74], p=0.007). Secondary interventions were more common in patients allocated EVAR (9.8% vs 5.8%, p=0.02). INTERPRETATION: In patients with large AAAs, treatment by EVAR reduced the 30-day operative mortality by two-thirds compared with open repair. Any change in clinical practice should await durability and longer term results.", "author" : [ { "dropping-particle" : "", "family" : "Greenhalgh", "given" : "R M", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Brown", "given" : "L C", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Kwong", "given" : "G P", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Powell", "given" : "J T", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Thompson", "given" : "S G", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "participants", "given" : "Evar trial", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Lancet", "id" : "ITEM-4", "issue" : "9437", "issued" : { "date-parts" : [ [ "2004" ] ] }, "note" : "Greenhalgh, R M\nBrown, L C\nKwong, G P S\nPowell, J T\nThompson, S G\neng\nClinical Trial\nComparative Study\nMulticenter Study\nRandomized Controlled Trial\nResearch Support, U.S. Gov't, P.H.S.\nEngland\nLondon, England\n2004/09/08 05:00\nLancet. 2004 Sep 4-10;364(9437):843-8. doi: 10.1016/S0140-6736(04)16979-1.", "page" : "843-848", "title" : "Comparison of endovascular aneurysm repair with open repair in patients with abdominal aortic aneurysm (EVAR trial 1), 30-day operative mortality results: randomised controlled trial", "type" : "article-journal", "volume" : "364" }, "uris" : [ "http://www.mendeley.com/documents/?uuid=0a834537-5faa-40ab-bdd2-7b8906b13570" ] }, { "id" : "ITEM-5", "itemData" : { "DOI" : "10.1056/NEJMoa0911056", "ISBN" : "1533-4406 (Electronic)\r0028-4793 (Linking)", "PMID" : "20382982", "abstract" : "BACKGROUND: Endovascular repair of abdominal aortic aneurysm was originally developed for patients who were considered to be physically ineligible for open surgical repair. Data are lacking on the question of whether endovascular repair reduces the rate of death among these patients. METHODS: From 1999 through 2004 at 33 hospitals in the United Kingdom, we randomly assigned 404 patients with large abdominal aortic aneurysms (> or = 5.5 cm in diameter) who were considered to be physically ineligible for open repair to undergo either endovascular repair or no repair; 197 patients were assigned to undergo endovascular repair, and 207 were assigned to have no intervention. Patients were followed for rates of death, graft-related complications and reinterventions, and costs until the end of 2009. Cox regression was used to compare outcomes in the two groups. RESULTS: The 30-day operative mortality was 7.3% in the endovascular-repair group. The overall rate of aneurysm rupture in the no-intervention group was 12.4 (95% confidence interval [CI], 9.6 to 16.2) per 100 person-years. Aneurysm-related mortality was lower in the endovascular-repair group (adjusted hazard ratio, 0.53; 95% CI, 0.32 to 0.89; P=0.02). This advantage did not result in any benefit in terms of total mortality (adjusted hazard ratio, 0.99; 95% CI, 0.78 to 1.27; P=0.97). A total of 48% of patients who survived endovascular repair had graft-related complications, and 27% required reintervention within the first 6 years. During 8 years of follow-up, endovascular repair was considerably more expensive than no repair (cost difference, 9,826 pounds sterling [U.S. $14,867]; 95% CI, 7,638 to 12,013 [11,556 to 18,176]). CONCLUSIONS: In this randomized trial involving patients who were physically ineligible for open repair, endovascular repair of abdominal aortic aneurysm was associated with a significantly lower rate of aneurysm-related mortality than no repair. However, endovascular repair was not associated with a reduction in the rate of death from any cause. The rates of graft-related complications and reinterventions were higher with endovascular repair, and it was more costly. (Current Controlled Trials number, ISRCTN55703451.)", "author" : [ { "dropping-particle" : "", "family" : "United Kingdom", "given" : "Evar Trial Investigators", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Greenhalgh", "given" : "R M", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Brown", "given" : "L C", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Powell", "given" : "J T", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Thompson", "given" : "S G", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Epstein", "given" : "D", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "N Engl J Med", "id" : "ITEM-5", "issue" : "20", "issued" : { "date-parts" : [ [ "2010" ] ] }, "note" : "Greenhalgh, Roger M\nBrown, Louise C\nPowell, Janet T\nThompson, Simon G\nEpstein, David\neng\nMC_U105260792/Medical Research Council/United Kingdom\nRG/08/014/24067/British Heart Foundation/United Kingdom\nMulticenter Study\nRandomized Controlled Trial\nResearch Support, Non-U.S. Gov't\n2010/04/13 06:00\nN Engl J Med. 2010 May 20;362(20):1872-80. doi: 10.1056/NEJMoa0911056. Epub 2010 Apr 11.", "page" : "1872-1880", "title" : "Endovascular repair of aortic aneurysm in patients physically ineligible for open repair", "type" : "article-journal", "volume" : "362" }, "uris" : [ "http://www.mendeley.com/documents/?uuid=2b95ac76-b90a-4166-82b0-e1db7960a139" ] }, { "id" : "ITEM-6", "itemData" : { "DOI" : "10.1001/jama.2009.1426", "ISBN" : "1538-3598 (Electronic)\r0098-7484 (Linking)", "PMID" : "19826022", "abstract" : "CONTEXT: Limited data are available to assess whether endovascular repair of abdominal aortic aneurysm (AAA) improves short-term outcomes compared with traditional open repair. OBJECTIVE: To compare postoperative outcomes up to 2 years after endovascular or open repair of AAA in a planned interim report of a 9-year trial. DESIGN, SETTING, AND PATIENTS: A randomized, multicenter clinical trial of 881 veterans (aged > or = 49 years) from 42 Veterans Affairs Medical Centers with eligible AAA who were candidates for both elective endovascular repair and open repair of AAA. The trial is ongoing and this report describes the period between October 15, 2002, and October 15, 2008. INTERVENTION: Elective endovascular (n = 444) or open (n = 437) repair of AAA. MAIN OUTCOME MEASURES: Procedure failure, secondary therapeutic procedures, length of stay, quality of life, erectile dysfunction, major morbidity, and mortality. RESULTS: Mean follow-up was 1.8 years. Perioperative mortality (30 days or inpatient) was lower for endovascular repair (0.5% vs 3.0%; P = .004), but there was no significant difference in mortality at 2 years (7.0% vs 9.8%, P = .13). Patients in the endovascular repair group had reduced median procedure time (2.9 vs 3.7 hours), blood loss (200 vs 1000 mL), transfusion requirement (0 vs 1.0 units), duration of mechanical ventilation (3.6 vs 5.0 hours), hospital stay (3 vs 7 days), and intensive care unit stay (1 vs 4 days), but required substantial exposure to fluoroscopy and contrast. There were no differences between the 2 groups in major morbidity, procedure failure, secondary therapeutic procedures, aneurysm-related hospitalizations, health-related quality of life, or erectile function. CONCLUSIONS: In this report of short-term outcomes after elective AAA repair, perioperative mortality was low for both procedures and lower for endovascular than open repair. The early advantage of endovascular repair was not offset by increased morbidity or mortality in the first 2 years after repair. Longer-term outcome data are needed to fully assess the relative merits of the 2 procedures. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT00094575.", "author" : [ { "dropping-particle" : "", "family" : "Lederle", "given" : "F A", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Freischlag", "given" : "J A", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Kyriakides", "given" : "T C", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Padberg Jr.", "given" : "F T", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Matsumura", "given" : "J S", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Kohler", "given" : "T R", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Lin", "given" : "P H", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Jean-Claude", "given" : "J M", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Cikrit", "given" : "D F", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Swanson", "given" : "K M", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Peduzzi", "given" : "P N", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Open Versus Endovascular Repair Veterans Affairs Cooperative Study", "given" : "Group", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "JAMA", "id" : "ITEM-6", "issue" : "14", "issued" : { "date-parts" : [ [ "2009" ] ] }, "note" : "Lederle, Frank A\nFreischlag, Julie A\nKyriakides, Tassos C\nPadberg, Frank T Jr\nMatsumura, Jon S\nKohler, Ted R\nLin, Peter H\nJean-Claude, Jessie M\nCikrit, Dolores F\nSwanson, Kathleen M\nPeduzzi, Peter N\n(OVER)\neng\nMulticenter Study\nRandomized Controlled Trial\nResearch Support, U.S. Gov't, Non-P.H.S.\n2009/10/15 06:00\nJAMA. 2009 Oct 14;302(14):1535-42. doi: 10.1001/jama.2009.1426.", "page" : "1535-1542", "title" : "Outcomes following endovascular vs open repair of abdominal aortic aneurysm: a randomized trial", "type" : "article-journal", "volume" : "302" }, "uris" : [ "http://www.mendeley.com/documents/?uuid=969be797-6b8d-4e82-bd52-63716debfeb3" ] }, { "id" : "ITEM-7", "itemData" : { "DOI" : "10.1016/S0140-6736(16)31135-7", "ISBN" : "1474-547X (Electronic)\r0140-6736 (Linking)", "PMID" : "27743617", "abstract" : "BACKGROUND: Short-term survival benefits of endovascular aneurysm repair (EVAR) versus open repair of intact abdominal aortic aneurysms have been shown in randomised trials, but this early survival benefit is lost after a few years. We investigated whether EVAR had a long-term survival benefit compared with open repair. METHODS: We used data from the EVAR randomised controlled trial (EVAR trial 1), which enrolled 1252 patients from 37 centres in the UK between Sept 1, 1999, and Aug 31, 2004. Patients had to be aged 60 years or older, have aneurysms of at least 5.5 cm in diameter, and deemed suitable and fit for either EVAR or open repair. Eligible patients were randomly assigned (1:1) using computer-generated sequences of randomly permuted blocks stratified by centre to receive either EVAR (n=626) or open repair (n=626). Patients and treating clinicians were aware of group assignments, no masking was used. The primary analysis compared total and aneurysm-related deaths in groups until mid-2015 in the intention-to-treat population. This trial is registered at ISRCTN (ISRCTN55703451). FINDINGS: We recruited 1252 patients between Sept 1, 1999, and Aug 31, 2004. 25 patients (four for mortality outcome) were lost to follow-up by June 30, 2015. Over a mean of 12.7 years (SD 1.5; maximum 15.8 years) of follow-up, we recorded 9.3 deaths per 100 person-years in the EVAR group and 8.9 deaths per 100 person-years in the open-repair group (adjusted hazard ratio [HR] 1.11, 95% CI 0.97-1.27, p=0.14). At 0-6 months after randomisation, patients in the EVAR group had a lower mortality (adjusted HR 0.61, 95% CI 0.37-1.02 for total mortality; and 0.47, 0.23-0.93 for aneurysm-related mortality, p=0.031), but beyond 8 years of follow-up open-repair had a significantly lower mortality (adjusted HR 1.25, 95% CI 1.00-1.56, p=0.048 for total mortality; and 5.82, 1.64-20.65, p=0.0064 for aneurysm-related mortality). The increased aneurysm-related mortality in the EVAR group after 8 years was mainly attributable to secondary aneurysm sac rupture (13 deaths [7%] in EVAR vs two [1%] in open repair), with increased cancer mortality also observed in the EVAR group. INTERPRETATION: EVAR has an early survival benefit but an inferior late survival compared with open repair, which needs to be addressed by lifelong surveillance of EVAR and re-intervention if necessary. FUNDING: UK National Institute for Health Research, Camelia Botnar Arterial Research Foundation.", "author" : [ { "dropping-particle" : "", "family" : "Patel", "given" : "R", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Sweeting", "given" : "M J", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Powell", "given" : "J T", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Greenhalgh", "given" : "R M", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "investigators", "given" : "Evar trial", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Lancet", "id" : "ITEM-7", "issue" : "10058", "issued" : { "date-parts" : [ [ "2016" ] ] }, "note" : "Patel, Rajesh\nSweeting, Michael J\nPowell, Janet T\nGreenhalgh, Roger M\neng\nMulticenter Study\nRandomized Controlled Trial\nResearch Support, Non-U.S. Gov't\nEngland\nLondon, England\n2016/10/17 06:00\nLancet. 2016 Nov 12;388(10058):2366-2374. doi: 10.1016/S0140-6736(16)31135-7. Epub 2016 Oct 12.", "page" : "2366-2374", "title" : "Endovascular versus open repair of abdominal aortic aneurysm in 15-years' follow-up of the UK endovascular aneurysm repair trial 1 (EVAR trial 1): a randomised controlled trial", "type" : "article-journal", "volume" : "388" }, "uris" : [ "http://www.mendeley.com/documents/?uuid=355dd8c6-9d9d-4c60-b691-d903a7ca9557" ] } ], "mendeley" : { "formattedCitation" : "167\u2013173", "plainTextFormattedCitation" : "167\u2013173", "previouslyFormattedCitation" : "167\u2013173" }, "properties" : { }, "schema" : "https://github.com/citation-style-language/schema/raw/master/csl-citation.json" }167173 The DREAM (Dutch Randomized Endovascular Aneurysm Management) trial showed a benefit of EVAR vs. open repair with regard to 30-day mortality (1.2% vs. 4.6%; P = 0.10), complication rates (11.7% vs. 26.4%; P <0.001) and length of hospital stay (6 vs. 13 days; P <0.001).ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1056/NEJMoa042002", "ISBN" : "1533-4406 (Electronic)\r0028-4793 (Linking)", "PMID" : "15483279", "abstract" : "BACKGROUND: Although the initial results of endovascular repair of abdominal aortic aneurysms were promising, current evidence from controlled studies does not convincingly show a reduction in 30-day mortality relative to that achieved with open repair. METHODS: We conducted a multicenter, randomized trial comparing open repair with endovascular repair in 345 patients who had received a diagnosis of abdominal aortic aneurysm of at least 5 cm in diameter and who were considered suitable candidates for both techniques. The outcome events analyzed were operative (30-day) mortality and two composite end points of operative mortality and severe complications and operative mortality and moderate or severe complications. RESULTS: The operative mortality rate was 4.6 percent in the open-repair group (8 of 174 patients; 95 percent confidence interval, 2.0 to 8.9 percent) and 1.2 percent in the endovascular-repair group (2 of 171 patients; 95 percent confidence interval, 0.1 to 4.2 percent), resulting in a risk ratio of 3.9 (95 percent confidence interval, 0.9 to 32.9). The combined rate of operative mortality and severe complications was 9.8 percent in the open-repair group (17 of 174 patients; 95 percent confidence interval, 5.8 to 15.2 percent) and 4.7 percent in the endovascular-repair group (8 of 171 patients; 95 percent confidence interval, 2.0 to 9.0 percent), resulting in a risk ratio of 2.1 (95 percent confidence interval, 0.9 to 5.4). CONCLUSIONS: On the basis of the overall results of this trial, endovascular repair is preferable to open repair in patients who have an abdominal aortic aneurysm that is at least 5 cm in diameter. Long-term follow-up is needed to determine whether this advantage is sustained.", "author" : [ { "dropping-particle" : "", "family" : "Prinssen", "given" : "M", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Verhoeven", "given" : "E L", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Buth", "given" : "J", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Cuypers", "given" : "P W", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Sambeek", "given" : "M R", "non-dropping-particle" : "van", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Balm", "given" : "R", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Buskens", "given" : "E", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Grobbee", "given" : "D E", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Blankensteijn", "given" : "J D", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Dutch Randomized Endovascular Aneurysm Management Trial", "given" : "Group", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "N Engl J Med", "id" : "ITEM-1", "issue" : "16", "issued" : { "date-parts" : [ [ "2004" ] ] }, "note" : "Prinssen, Monique\nVerhoeven, Eric L G\nButh, Jaap\nCuypers, Philippe W M\nvan Sambeek, Marc R H M\nBalm, Ron\nBuskens, Erik\nGrobbee, Diederick E\nBlankensteijn, Jan D\n(DREAM)\neng\nClinical Trial\nComparative Study\nMulticenter Study\nRandomized Controlled Trial\nResearch Support, Non-U.S. Gov't\n2004/10/16 09:00\nN Engl J Med. 2004 Oct 14;351(16):1607-18. doi: 10.1056/NEJMoa042002.", "page" : "1607-1618", "title" : "A randomized trial comparing conventional and endovascular repair of abdominal aortic aneurysms", "type" : "article-journal", "volume" : "351" }, "uris" : [ "http://www.mendeley.com/documents/?uuid=42fa4826-7adf-41ad-8439-53d4891ca0d1" ] } ], "mendeley" : { "formattedCitation" : "167", "plainTextFormattedCitation" : "167", "previouslyFormattedCitation" : "167" }, "properties" : { }, "schema" : "https://github.com/citation-style-language/schema/raw/master/csl-citation.json" }167 Nevertheless, the early perioperative survival advantage of EVAR was not sustained after the first postoperative year, while EVAR was associated with higher reintervention rates compared to open repair during 6 years of follow-up (29.6% versus 18.1%; P = 0.03).ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1056/NEJMoa051255", "ISBN" : "1533-4406 (Electronic)\r0028-4793 (Linking)", "PMID" : "15944424", "abstract" : "BACKGROUND: Two randomized trials have shown better outcomes with elective endovascular repair of abdominal aortic aneurysms than with conventional open repair in the first month after the procedure. We investigated whether this advantage is sustained beyond the perioperative period. METHODS: We conducted a multicenter, randomized trial comparing open repair with endovascular repair in 351 patients who had received a diagnosis of abdominal aortic aneurysm of at least 5 cm in diameter and who were considered suitable candidates for both techniques. Survival after randomization was calculated with the use of Kaplan-Meier analysis and compared with the use of the log-rank test on an intention-to-treat-basis. RESULTS: Two years after randomization, the cumulative survival rates were 89.6 percent for open repair and 89.7 percent for endovascular repair (difference, -0.1 percentage point; 95 percent confidence interval, -6.8 to 6.7 percentage points). The cumulative rates of aneurysm-related death were 5.7 percent for open repair and 2.1 percent for endovascular repair (difference, 3.7 percentage points; 95 percent confidence interval, -0.5 to 7.9 percentage points). This advantage of endovascular repair over open repair was entirely accounted for by events occurring in the perioperative period, with no significant difference in subsequent aneurysm-related mortality. The rate of survival free of moderate or severe complications was also similar in the two groups at two years (at 65.9 percent for open repair and 65.6 percent for endovascular repair; difference, 0.3 percentage point; 95 percent confidence interval, -10.0 to 10.6 percentage points). CONCLUSIONS: The perioperative survival advantage with endovascular repair as compared with open repair is not sustained after the first postoperative year.", "author" : [ { "dropping-particle" : "", "family" : "Blankensteijn", "given" : "J D", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Jong", "given" : "S E", "non-dropping-particle" : "de", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Prinssen", "given" : "M", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Ham", "given" : "A C", "non-dropping-particle" : "van der", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Buth", "given" : "J", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Sterkenburg", "given" : "S M", "non-dropping-particle" : "van", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Verhagen", "given" : "H J", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Buskens", "given" : "E", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Grobbee", "given" : "D E", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Dutch Randomized Endovascular Aneurysm Management Trial", "given" : "Group", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "N Engl J Med", "id" : "ITEM-1", "issue" : "23", "issued" : { "date-parts" : [ [ "2005" ] ] }, "note" : "Blankensteijn, Jan D\nde Jong, Sjors E C A\nPrinssen, Monique\nvan der Ham, Arie C\nButh, Jaap\nvan Sterkenburg, Steven M M\nVerhagen, Hence J M\nBuskens, Erik\nGrobbee, Diederick E\n(DREAM)\neng\nClinical Trial\nComparative Study\nMulticenter Study\nRandomized Controlled Trial\nResearch Support, Non-U.S. Gov't\n2005/06/10 09:00\nN Engl J Med. 2005 Jun 9;352(23):2398-405. doi: 10.1056/NEJMoa051255.", "page" : "2398-2405", "title" : "Two-year outcomes after conventional or endovascular repair of abdominal aortic aneurysms", "type" : "article-journal", "volume" : "352" }, "uris" : [ "http://www.mendeley.com/documents/?uuid=66e3725e-a437-4e74-b7fe-78b59fe876c5" ] }, { "id" : "ITEM-2", "itemData" : { "DOI" : "10.1056/NEJMoa0909499", "ISBN" : "1533-4406 (Electronic)\r0028-4793 (Linking)", "PMID" : "20484396", "abstract" : "BACKGROUND: For patients with large abdominal aortic aneurysms, randomized trials have shown an initial overall survival benefit for elective endovascular repair over conventional open repair. This survival difference, however, was no longer significant in the second year after the procedure. Information regarding the comparative outcome more than 2 years after surgery is important for clinical decision making. METHODS: We conducted a long-term, multicenter, randomized, controlled trial comparing open repair with endovascular repair in 351 patients with an abdominal aortic aneurysm of at least 5 cm in diameter who were considered suitable candidates for both techniques. The primary outcomes were rates of death from any cause and reintervention. Survival was calculated with the use of Kaplan-Meier methods on an intention-to-treat basis. RESULTS: We randomly assigned 178 patients to undergo open repair and 173 to undergo endovascular repair. Six years after randomization, the cumulative survival rates were 69.9% for open repair and 68.9% for endovascular repair (difference, 1.0 percentage point; 95% confidence interval [CI], -8.8 to 10.8; P=0.97). The cumulative rates of freedom from secondary interventions were 81.9% for open repair and 70.4% for endovascular repair (difference, 11.5 percentage points; 95% CI, 2.0 to 21.0; P=0.03). CONCLUSIONS: Six years after randomization, endovascular and open repair of abdominal aortic aneurysm resulted in similar rates of survival. The rate of secondary interventions was significantly higher for endovascular repair. (ClinicalTrials.gov number, NCT00421330.)", "author" : [ { "dropping-particle" : "", "family" : "Bruin", "given" : "J L", "non-dropping-particle" : "De", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Baas", "given" : "A F", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Buth", "given" : "J", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Prinssen", "given" : "M", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Verhoeven", "given" : "E L", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Cuypers", "given" : "P W", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Sambeek", "given" : "M R", "non-dropping-particle" : "van", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Balm", "given" : "R", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Grobbee", "given" : "D E", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Blankensteijn", "given" : "J D", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Group", "given" : "Dream Study", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "N Engl J Med", "id" : "ITEM-2", "issue" : "20", "issued" : { "date-parts" : [ [ "2010" ] ] }, "note" : "De Bruin, Jorg L\nBaas, Annette F\nButh, Jaap\nPrinssen, Monique\nVerhoeven, Eric L G\nCuypers, Philippe W M\nvan Sambeek, Marc R H M\nBalm, Ron\nGrobbee, Diederick E\nBlankensteijn, Jan D\neng\nComparative Study\nMulticenter Study\nRandomized Controlled Trial\nResearch Support, Non-U.S. Gov't\n2010/05/21 06:00\nN Engl J Med. 2010 May 20;362(20):1881-9. doi: 10.1056/NEJMoa0909499.", "page" : "1881-1889", "title" : "Long-term outcome of open or endovascular repair of abdominal aortic aneurysm", "type" : "article-journal", "volume" : "362" }, "uris" : [ "http://www.mendeley.com/documents/?uuid=ccd90be1-cd78-433a-814a-c7298954aba1" ] } ], "mendeley" : { "formattedCitation" : "168,169", "plainTextFormattedCitation" : "168,169", "previouslyFormattedCitation" : "168,169" }, "properties" : { }, "schema" : "https://github.com/citation-style-language/schema/raw/master/csl-citation.json" }168,169
Similarly the UK EVAR 1 (UK Endovascular Aneurysm Repair 1) trial, showed an early survival advantage for EVAR, which, however, was not sustained at the 4-year follow-up.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1016/S0140-6736(04)16979-1", "ISBN" : "1474-547X (Electronic)\r0140-6736 (Linking)", "PMID" : "15351191", "abstract" : "BACKGROUND: Endovascular aneurysm repair (EVAR) is a new technology to treat patients with abdominal aortic aneurysm (AAA) when the anatomy is suitable. Uncertainty exists about how endovascular repair compares with conventional open surgery. EVAR trial 1 was instigated to compare these treatments in patients judged fit for open AAA repair. METHODS: Between 1999 and 2003, 1082 elective (non-emergency) patients were randomised to receive either EVAR (n=543) or open AAA repair (n=539). Patients aged at least 60 years with aneurysms of diameter 5.5 cm or more, who were fit enough for open surgical repair (anaesthetically and medically well enough for the procedure), were recruited for the study at 41 British hospitals proficient in the EVAR technique. The primary outcome measure is all-cause mortality and these results will be released in 2005. The primary analysis presented here is operative mortality by intention to treat and a secondary analysis was done in per-protocol patients. FINDINGS: Patients (983 men, 99 women) had a mean age of 74 years (SD 6) and mean AAA diameter of 6.5 cm (SD 1). 1047 (97%) patients underwent AAA repair and 1008 (93%) received their allocated treatment. 30-day mortality in the EVAR group was 1.7% (9/531) versus 4.7% (24/516) in the open repair group (odds ratio 0.35 [95% CI 0.16-0.77], p=0.009). By per-protocol analysis, 30-day mortality for EVAR was 1.6% (8/512) versus 4.6% (23/496) for open repair (0.33 [0.15-0.74], p=0.007). Secondary interventions were more common in patients allocated EVAR (9.8% vs 5.8%, p=0.02). INTERPRETATION: In patients with large AAAs, treatment by EVAR reduced the 30-day operative mortality by two-thirds compared with open repair. Any change in clinical practice should await durability and longer term results.", "author" : [ { "dropping-particle" : "", "family" : "Greenhalgh", "given" : "R M", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Brown", "given" : "L C", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Kwong", "given" : "G P", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Powell", "given" : "J T", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Thompson", "given" : "S G", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "participants", "given" : "Evar trial", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Lancet", "id" : "ITEM-1", "issue" : "9437", "issued" : { "date-parts" : [ [ "2004" ] ] }, "note" : "Greenhalgh, R M\nBrown, L C\nKwong, G P S\nPowell, J T\nThompson, S G\neng\nClinical Trial\nComparative Study\nMulticenter Study\nRandomized Controlled Trial\nResearch Support, U.S. Gov't, P.H.S.\nEngland\nLondon, England\n2004/09/08 05:00\nLancet. 2004 Sep 4-10;364(9437):843-8. doi: 10.1016/S0140-6736(04)16979-1.", "page" : "843-848", "title" : "Comparison of endovascular aneurysm repair with open repair in patients with abdominal aortic aneurysm (EVAR trial 1), 30-day operative mortality results: randomised controlled trial", "type" : "article-journal", "volume" : "364" }, "uris" : [ "http://www.mendeley.com/documents/?uuid=0a834537-5faa-40ab-bdd2-7b8906b13570" ] }, { "id" : "ITEM-2", "itemData" : { "DOI" : "10.1016/S0140-6736(05)66627-5", "ISBN" : "1474-547X (Electronic)\r0140-6736 (Linking)", "PMID" : "15978925", "abstract" : "BACKGROUND: Although endovascular aneurysm repair (EVAR) has a lower 30-day operative mortality than open repair, the long-term results of EVAR are uncertain. We instigated EVAR trial 1 to compare these two treatments in terms of mortality, durability, health-related quality of life (HRQL), and costs for patients with large abdominal aortic aneurysm (AAA). METHODS: We did a randomised controlled trial of 1082 patients aged 60 years or older who had aneurysms of at least 5.5 cm in diameter and who had been referred to one of 34 hospitals proficient in the EVAR technique. We assigned patients who were anatomically suitable for EVAR and fit for an open repair to EVAR (n=543) or open repair (n=539). Our primary endpoint was all-cause mortality, with secondary endpoints of aneurysm related mortality, HRQL, postoperative complications, and hospital costs. Analyses were by intention to treat. FINDINGS: 94% (1017 of 1082) of patients complied with their allocated treatment and 209 died by the end of follow-up on Dec 31, 2004 (53 of aneurysm-related causes). 4 years after randomisation, all-cause mortality was similar in the two groups (about 28%; hazard ratio 0.90, 95% CI 0.69-1.18, p=0.46), although there was a persistent reduction in aneurysm-related deaths in the EVAR group (4%vs 7%; 0.55, 0.31-0.96, p=0.04). The proportion of patients with postoperative complications within 4 years of randomisation was 41% in the EVAR group and 9% in the open repair group (4.9, 3.5-6.8, p<0.0001). After 12 months there was negligible difference in HRQL between the two groups. The mean hospital costs per patient up to 4 years were UK pound sterling 13,257 for the EVAR group versus pound sterling 9946 for the open repair group (mean difference pound sterling 3311, SE 690). INTERPRETATION: Compared with open repair, EVAR offers no advantage with respect to all-cause mortality and HRQL, is more expensive, and leads to a greater number of complications and reinterventions. However, it does result in a 3% better aneurysm-related survival. The continuing need for interventions mandates ongoing surveillance and longer follow-up of EVAR for detailed cost-effectiveness assessment.", "author" : [ { "dropping-particle" : "", "family" : "participants", "given" : "Evar trial", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Lancet", "id" : "ITEM-2", "issue" : "9478", "issued" : { "date-parts" : [ [ "2005" ] ] }, "note" : "eng\nClinical Trial\nComparative Study\nMulticenter Study\nRandomized Controlled Trial\nResearch Support, Non-U.S. Gov't\nEngland\nLondon, England\n2005/06/28 09:00\nLancet. 2005 Jun 25-Jul 1;365(9478):2179-86. doi: 10.1016/S0140-6736(05)66627-5.", "page" : "2179-2186", "title" : "Endovascular aneurysm repair versus open repair in patients with abdominal aortic aneurysm (EVAR trial 1): randomised controlled trial", "type" : "article-journal", "volume" : "365" }, "uris" : [ "http://www.mendeley.com/documents/?uuid=63561a64-b4fa-4181-bf43-f947de23415a" ] } ], "mendeley" : { "formattedCitation" : "170,174", "plainTextFormattedCitation" : "170,174", "previouslyFormattedCitation" : "170,174" }, "properties" : { }, "schema" : "https://github.com/citation-style-language/schema/raw/master/csl-citation.json" }170,174 At 15 years of follow-up EVAR was associated with lower survival rates compared to open repair mainly due to increased secondary aneurysm sac rupture, but also increased cancer mortality in the EVAR group.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1016/S0140-6736(16)31135-7", "ISBN" : "1474-547X (Electronic)\r0140-6736 (Linking)", "PMID" : "27743617", "abstract" : "BACKGROUND: Short-term survival benefits of endovascular aneurysm repair (EVAR) versus open repair of intact abdominal aortic aneurysms have been shown in randomised trials, but this early survival benefit is lost after a few years. We investigated whether EVAR had a long-term survival benefit compared with open repair. METHODS: We used data from the EVAR randomised controlled trial (EVAR trial 1), which enrolled 1252 patients from 37 centres in the UK between Sept 1, 1999, and Aug 31, 2004. Patients had to be aged 60 years or older, have aneurysms of at least 5.5 cm in diameter, and deemed suitable and fit for either EVAR or open repair. Eligible patients were randomly assigned (1:1) using computer-generated sequences of randomly permuted blocks stratified by centre to receive either EVAR (n=626) or open repair (n=626). Patients and treating clinicians were aware of group assignments, no masking was used. The primary analysis compared total and aneurysm-related deaths in groups until mid-2015 in the intention-to-treat population. This trial is registered at ISRCTN (ISRCTN55703451). FINDINGS: We recruited 1252 patients between Sept 1, 1999, and Aug 31, 2004. 25 patients (four for mortality outcome) were lost to follow-up by June 30, 2015. Over a mean of 12.7 years (SD 1.5; maximum 15.8 years) of follow-up, we recorded 9.3 deaths per 100 person-years in the EVAR group and 8.9 deaths per 100 person-years in the open-repair group (adjusted hazard ratio [HR] 1.11, 95% CI 0.97-1.27, p=0.14). At 0-6 months after randomisation, patients in the EVAR group had a lower mortality (adjusted HR 0.61, 95% CI 0.37-1.02 for total mortality; and 0.47, 0.23-0.93 for aneurysm-related mortality, p=0.031), but beyond 8 years of follow-up open-repair had a significantly lower mortality (adjusted HR 1.25, 95% CI 1.00-1.56, p=0.048 for total mortality; and 5.82, 1.64-20.65, p=0.0064 for aneurysm-related mortality). The increased aneurysm-related mortality in the EVAR group after 8 years was mainly attributable to secondary aneurysm sac rupture (13 deaths [7%] in EVAR vs two [1%] in open repair), with increased cancer mortality also observed in the EVAR group. INTERPRETATION: EVAR has an early survival benefit but an inferior late survival compared with open repair, which needs to be addressed by lifelong surveillance of EVAR and re-intervention if necessary. FUNDING: UK National Institute for Health Research, Camelia Botnar Arterial Research Foundation.", "author" : [ { "dropping-particle" : "", "family" : "Patel", "given" : "R", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Sweeting", "given" : "M J", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Powell", "given" : "J T", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Greenhalgh", "given" : "R M", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "investigators", "given" : "Evar trial", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Lancet", "id" : "ITEM-1", "issue" : "10058", "issued" : { "date-parts" : [ [ "2016" ] ] }, "note" : "Patel, Rajesh\nSweeting, Michael J\nPowell, Janet T\nGreenhalgh, Roger M\neng\nMulticenter Study\nRandomized Controlled Trial\nResearch Support, Non-U.S. Gov't\nEngland\nLondon, England\n2016/10/17 06:00\nLancet. 2016 Nov 12;388(10058):2366-2374. doi: 10.1016/S0140-6736(16)31135-7. Epub 2016 Oct 12.", "page" : "2366-2374", "title" : "Endovascular versus open repair of abdominal aortic aneurysm in 15-years' follow-up of the UK endovascular aneurysm repair trial 1 (EVAR trial 1): a randomised controlled trial", "type" : "article-journal", "volume" : "388" }, "uris" : [ "http://www.mendeley.com/documents/?uuid=355dd8c6-9d9d-4c60-b691-d903a7ca9557" ] } ], "mendeley" : { "formattedCitation" : "173", "plainTextFormattedCitation" : "173", "previouslyFormattedCitation" : "173" }, "properties" : { }, "schema" : "https://github.com/citation-style-language/schema/raw/master/csl-citation.json" }173
There have been significant improvements in stent-graft technology that may have a positive impact on EVAR durability.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1056/NEJMoa0911056", "ISBN" : "1533-4406 (Electronic)\r0028-4793 (Linking)", "PMID" : "20382982", "abstract" : "BACKGROUND: Endovascular repair of abdominal aortic aneurysm was originally developed for patients who were considered to be physically ineligible for open surgical repair. Data are lacking on the question of whether endovascular repair reduces the rate of death among these patients. METHODS: From 1999 through 2004 at 33 hospitals in the United Kingdom, we randomly assigned 404 patients with large abdominal aortic aneurysms (> or = 5.5 cm in diameter) who were considered to be physically ineligible for open repair to undergo either endovascular repair or no repair; 197 patients were assigned to undergo endovascular repair, and 207 were assigned to have no intervention. Patients were followed for rates of death, graft-related complications and reinterventions, and costs until the end of 2009. Cox regression was used to compare outcomes in the two groups. RESULTS: The 30-day operative mortality was 7.3% in the endovascular-repair group. The overall rate of aneurysm rupture in the no-intervention group was 12.4 (95% confidence interval [CI], 9.6 to 16.2) per 100 person-years. Aneurysm-related mortality was lower in the endovascular-repair group (adjusted hazard ratio, 0.53; 95% CI, 0.32 to 0.89; P=0.02). This advantage did not result in any benefit in terms of total mortality (adjusted hazard ratio, 0.99; 95% CI, 0.78 to 1.27; P=0.97). A total of 48% of patients who survived endovascular repair had graft-related complications, and 27% required reintervention within the first 6 years. During 8 years of follow-up, endovascular repair was considerably more expensive than no repair (cost difference, 9,826 pounds sterling [U.S. $14,867]; 95% CI, 7,638 to 12,013 [11,556 to 18,176]). CONCLUSIONS: In this randomized trial involving patients who were physically ineligible for open repair, endovascular repair of abdominal aortic aneurysm was associated with a significantly lower rate of aneurysm-related mortality than no repair. However, endovascular repair was not associated with a reduction in the rate of death from any cause. The rates of graft-related complications and reinterventions were higher with endovascular repair, and it was more costly. (Current Controlled Trials number, ISRCTN55703451.)", "author" : [ { "dropping-particle" : "", "family" : "United Kingdom", "given" : "Evar Trial Investigators", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Greenhalgh", "given" : "R M", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Brown", "given" : "L C", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Powell", "given" : "J T", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Thompson", "given" : "S G", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Epstein", "given" : "D", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "N Engl J Med", "id" : "ITEM-1", "issue" : "20", "issued" : { "date-parts" : [ [ "2010" ] ] }, "note" : "Greenhalgh, Roger M\nBrown, Louise C\nPowell, Janet T\nThompson, Simon G\nEpstein, David\neng\nMC_U105260792/Medical Research Council/United Kingdom\nRG/08/014/24067/British Heart Foundation/United Kingdom\nMulticenter Study\nRandomized Controlled Trial\nResearch Support, Non-U.S. Gov't\n2010/04/13 06:00\nN Engl J Med. 2010 May 20;362(20):1872-80. doi: 10.1056/NEJMoa0911056. Epub 2010 Apr 11.", "page" : "1872-1880", "title" : "Endovascular repair of aortic aneurysm in patients physically ineligible for open repair", "type" : "article-journal", "volume" : "362" }, "uris" : [ "http://www.mendeley.com/documents/?uuid=2b95ac76-b90a-4166-82b0-e1db7960a139" ] }, { "id" : "ITEM-2", "itemData" : { "DOI" : "10.1001/jama.2009.1426", "ISBN" : "1538-3598 (Electronic)\r0098-7484 (Linking)", "PMID" : "19826022", "abstract" : "CONTEXT: Limited data are available to assess whether endovascular repair of abdominal aortic aneurysm (AAA) improves short-term outcomes compared with traditional open repair. OBJECTIVE: To compare postoperative outcomes up to 2 years after endovascular or open repair of AAA in a planned interim report of a 9-year trial. DESIGN, SETTING, AND PATIENTS: A randomized, multicenter clinical trial of 881 veterans (aged > or = 49 years) from 42 Veterans Affairs Medical Centers with eligible AAA who were candidates for both elective endovascular repair and open repair of AAA. The trial is ongoing and this report describes the period between October 15, 2002, and October 15, 2008. INTERVENTION: Elective endovascular (n = 444) or open (n = 437) repair of AAA. MAIN OUTCOME MEASURES: Procedure failure, secondary therapeutic procedures, length of stay, quality of life, erectile dysfunction, major morbidity, and mortality. RESULTS: Mean follow-up was 1.8 years. Perioperative mortality (30 days or inpatient) was lower for endovascular repair (0.5% vs 3.0%; P = .004), but there was no significant difference in mortality at 2 years (7.0% vs 9.8%, P = .13). Patients in the endovascular repair group had reduced median procedure time (2.9 vs 3.7 hours), blood loss (200 vs 1000 mL), transfusion requirement (0 vs 1.0 units), duration of mechanical ventilation (3.6 vs 5.0 hours), hospital stay (3 vs 7 days), and intensive care unit stay (1 vs 4 days), but required substantial exposure to fluoroscopy and contrast. There were no differences between the 2 groups in major morbidity, procedure failure, secondary therapeutic procedures, aneurysm-related hospitalizations, health-related quality of life, or erectile function. CONCLUSIONS: In this report of short-term outcomes after elective AAA repair, perioperative mortality was low for both procedures and lower for endovascular than open repair. The early advantage of endovascular repair was not offset by increased morbidity or mortality in the first 2 years after repair. Longer-term outcome data are needed to fully assess the relative merits of the 2 procedures. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT00094575.", "author" : [ { "dropping-particle" : "", "family" : "Lederle", "given" : "F A", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Freischlag", "given" : "J A", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Kyriakides", "given" : "T C", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Padberg Jr.", "given" : "F T", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Matsumura", "given" : "J S", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Kohler", "given" : "T R", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Lin", "given" : "P H", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Jean-Claude", "given" : "J M", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Cikrit", "given" : "D F", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Swanson", "given" : "K M", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Peduzzi", "given" : "P N", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Open Versus Endovascular Repair Veterans Affairs Cooperative Study", "given" : "Group", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "JAMA", "id" : "ITEM-2", "issue" : "14", "issued" : { "date-parts" : [ [ "2009" ] ] }, "note" : "Lederle, Frank A\nFreischlag, Julie A\nKyriakides, Tassos C\nPadberg, Frank T Jr\nMatsumura, Jon S\nKohler, Ted R\nLin, Peter H\nJean-Claude, Jessie M\nCikrit, Dolores F\nSwanson, Kathleen M\nPeduzzi, Peter N\n(OVER)\neng\nMulticenter Study\nRandomized Controlled Trial\nResearch Support, U.S. Gov't, Non-P.H.S.\n2009/10/15 06:00\nJAMA. 2009 Oct 14;302(14):1535-42. doi: 10.1001/jama.2009.1426.", "page" : "1535-1542", "title" : "Outcomes following endovascular vs open repair of abdominal aortic aneurysm: a randomized trial", "type" : "article-journal", "volume" : "302" }, "uris" : [ "http://www.mendeley.com/documents/?uuid=969be797-6b8d-4e82-bd52-63716debfeb3" ] }, { "id" : "ITEM-3", "itemData" : { "DOI" : "10.1016/j.jvs.2010.10.124", "ISBN" : "1097-6809 (Electronic)\r0741-5214 (Linking)", "PMID" : "21276681", "abstract" : "BACKGROUND: Several studies, including three randomized controlled trials (RCTs), have shown that endovascular repair (EVAR) of abdominal aortic aneurysms (AAA) offered better early results than open surgical repair (OSR) but a similar medium-term to long-term mortality and a higher incidence of reinterventions. Thus, the role of EVAR, most notably in low-risk patients, remains debated. METHODS: The ACE (Anevrysme de l'aorte abdominale: Chirurgie versus Endoprothese) trial compared mortality and major adverse events after EVAR and OSR in patients with AAA anatomically suitable for EVAR and at low-risk or intermediate-risk for open surgery. A total of 316 patients with >5 cm aneurysms were randomized in institutions with proven expertise for both treatments: 299 patients were available for analysis, and 149 were assigned to OSR and 150 to EVAR. Patients were monitored for 5 years after treatment. Statistical analysis was by intention to treat. RESULTS: With a median follow-up of 3 years (range, 0-4.8 years), there was no difference in the cumulative survival free of death or major events rates between OSR and EVAR: 95.9% +/- 1.6% vs 93.2% +/- 2.1% at 1 year and 85.1% +/- 4.5% vs 82.4% +/- 3.7% at 3 years, respectively (P = .09). In-hospital mortality (0.6% vs 1.3%; P = 1.0), survival, and the percentage of minor complications were not statistically different. In the EVAR group, however, the crude percentage of reintervention was higher (2.4% vs 16%, P < .0001), with a trend toward a higher aneurysm-related mortality (0.7% vs 4%; P = .12). CONCLUSIONS: In patients with low to intermediate risk factors, open repair of AAA is as safe as EVAR and remains a more durable option.", "author" : [ { "dropping-particle" : "", "family" : "Becquemin", "given" : "J P", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Pillet", "given" : "J C", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Lescalie", "given" : "F", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Sapoval", "given" : "M", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Goueffic", "given" : "Y", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Lermusiaux", "given" : "P", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Steinmetz", "given" : "E", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Marzelle", "given" : "J", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "trialists", "given" : "A C E", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "J Vasc Surg", "id" : "ITEM-3", "issue" : "5", "issued" : { "date-parts" : [ [ "2011" ] ] }, "note" : "Becquemin, Jean-Pierre\nPillet, Jean-Chistophe\nLescalie, Francois\nSapoval, Marc\nGoueffic, Yann\nLermusiaux, Patrick\nSteinmetz, Eric\nMarzelle, Jean\neng\nComparative Study\nMulticenter Study\nRandomized Controlled Trial\nResearch Support, Non-U.S. Gov't\n2011/02/01 06:00\nJ Vasc Surg. 2011 May;53(5):1167-1173.e1. doi: 10.1016/j.jvs.2010.10.124. Epub 2011 Jan 26.", "page" : "1167-1173 e1", "title" : "A randomized controlled trial of endovascular aneurysm repair versus open surgery for abdominal aortic aneurysms in low- to moderate-risk patients", "type" : "article-journal", "volume" : "53" }, "uris" : [ "http://www.mendeley.com/documents/?uuid=44eb1e86-5e4a-4853-ae7b-c5259bccc0c4" ] } ], "mendeley" : { "formattedCitation" : "171,172,175", "plainTextFormattedCitation" : "171,172,175", "previouslyFormattedCitation" : "171,172,175" }, "properties" : { }, "schema" : "https://github.com/citation-style-language/schema/raw/master/csl-citation.json" }171,172,175 Materials have been improved (e.g. grafts of lower permeability, more flexible stent designs) and deployment mechanisms have been also revised to enable a more precise proximal deployment. Consequently, long-term outcomes of EVAR with the use of current stent-grafts may improve compared to those reported in the existing studies with previous generation stent-grafts. The more recent trials on open repair vs EVAR in ruptured patientsfor ruptured AAA show that EVAR has better short term results, also atpatient outcomes to three years, including cost-effectiveness and quality-of-life. But for in the longer term than three years, one needs to balance the higher operative mortality but good durability, associated with open repair, but god durability of open repair, andhas to be balanced against the lower operative early mortality, but also inferior durability of EVAR.
Aortic morphology influences EVAR outcomes. Performing EVAR in patients outside instructions for use is associated with inferior long-term outcomes.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "ISBN" : "1827-191X (Electronic)\r0021-9509 (Linking)", "PMID" : "23443586", "abstract" : "The aim of this paper was to review the current options for endovascular treatment of abdominal aortic aneurysms (AAAs) with short infrarenal neck. Studies reporting endovascular treatment of AAAs with short proximal neck were reviewed. Fenestrated endovascular aneurysm repair (F-EVAR) is most frequently reported for the treatment of patients with short neck AAA, with high technical success rates (>/= 99%), low operative mortality (/= 97%). Chimney-EVAR (Ch-EVAR) is far less reported, but also presents with high technical success rates (>97%), varying operative mortality rates (0-12.5%), and excellent short- and mid-term target vessel patency (>/= 96%). Ch-EVAR, however, seems to be associated with high postoperative stroke up to 6.3%, and increased proximal type I endoleak (5-31%). Standard EVAR performed outside manufacturers' instructions for use (IFU) is also documented in the treatment of short proximal neck AAA, but is associated with increased operative mortality and morbidity, type I endoleak, and migration, compared to standard EVAR in AAA with longer proximal neck length. F-EVAR currently represents the most validated and reliable endovascular option for the treatment of short-neck AAA. Ch-EVAR is feasible, but lacks long-term data. Its use seems only favored in acute high surgical risk patients, in elective cases complicated with unintentional renal artery coverage or in anatomies unsuitable for F-EVAR. Standard EVAR in short neck AAA is associated with poorer outcomes and should not be recommended as first choice.", "author" : [ { "dropping-particle" : "", "family" : "Katsargyris", "given" : "A", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Verhoeven", "given" : "E L", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "J Cardiovasc Surg (Torino)", "id" : "ITEM-1", "issue" : "1 Suppl 1", "issued" : { "date-parts" : [ [ "2013" ] ] }, "note" : "Katsargyris, A\nVerhoeven, E L G\neng\nReview\nItaly\n2013/03/06 06:00\nJ Cardiovasc Surg (Torino). 2013 Feb;54(1 Suppl 1):21-6.", "page" : "21-26", "title" : "Endovascular strategies for infrarenal aneurysms with short necks", "type" : "article-journal", "volume" : "54" }, "uris" : [ "http://www.mendeley.com/documents/?uuid=4e1bc20f-3db4-4959-af61-fbf95584ccb6" ] }, { "id" : "ITEM-2", "itemData" : { "DOI" : "10.1016/j.jamcollsurg.2015.12.037", "ISBN" : "1879-1190 (Electronic)\r1072-7515 (Linking)", "PMID" : "26905372", "abstract" : "BACKGROUND: A significant number of patients undergo endovascular repair of abdominal aortic aneurysms (EVAR) outside the instructions for use (IFU). This study will examine various aortic neck features and their predictors of clinical outcomes. STUDY DESIGN: We performed a retrospective analysis of prospectively collected data on EVAR patients. Neck features outside IFU were analyzed. Kaplan-Meier and multivariate analyses were used to predict their effect as single features, or in combination, on outcomes. RESULTS: Fifty-two percent of 526 patients had 1 or more features outside the IFU. The overall technical success rate was 99%, and perioperative complication rates were 7% and 12% for IFU vs outside IFU use, respectively (p = 0.04). Type I early endoleak and early intervention rates were 7% and 10% for IFU vs 18% and 24% for outside IFU (p = 0.0002 and p < 0.0001). At a mean follow-up of 30 months, freedom from late type I endoleak and late reintervention at 1, 2, and 3 years for IFU were 99.5%, 99.5%, and 98.4%, and 99.4%, 98%, and 96.8%; vs 98.9%, 98.1%, and 98.1%, and 97.5%, 96.2%, and 95.2% for outside IFU (p = 0.049 and 0.799), respectively. Survival rates at 1, 2, and 3 years for IFU were 97%, 93.5%, and 89.8%; vs 93.7%, 88.8%, and 86.3% for outside IFU (p = 0.035). Multivariate analysis showed that a neck angle > 60 degrees had odds ratios for death, sac expansion, and early intervention of 6, 2.6, and 3.3, respectively; neck length < 10 mm had odds ratios of 2.8 for deaths, 3.4 for early intervention, 4.6 for late reintervention, and 4.3 for late type I endoleak. CONCLUSIONS: Patients with neck features outside IFU can be treated with EVAR; however, they have higher rates of early and late type I endoleak, early intervention, and late death.", "author" : [ { "dropping-particle" : "", "family" : "AbuRahma", "given" : "A F", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Yacoub", "given" : "M", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Mousa", "given" : "A Y", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Abu-Halimah", "given" : "S", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Hass", "given" : "S M", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Kazil", "given" : "J", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "AbuRahma", "given" : "Z T", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Srivastava", "given" : "M", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Dean", "given" : "L S", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Stone", "given" : "P A", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "J Am Coll Surg", "id" : "ITEM-2", "issue" : "4", "issued" : { "date-parts" : [ [ "2016" ] ] }, "note" : "AbuRahma, Ali F\nYacoub, Michael\nMousa, Albeir Y\nAbu-Halimah, Shadi\nHass, Stephen M\nKazil, Jenna\nAbuRahma, Zachary T\nSrivastava, Mohit\nDean, L Scott\nStone, Patrick A\neng\nU54 GM104942/GM/NIGMS NIH HHS/\n2016/02/26 06:00\nJ Am Coll Surg. 2016 Apr;222(4):579-89. doi: 10.1016/j.jamcollsurg.2015.12.037. Epub 2016 Jan 13.", "page" : "579-589", "title" : "Aortic Neck Anatomic Features and Predictors of Outcomes in Endovascular Repair of Abdominal Aortic Aneurysms Following vs Not Following Instructions for Use", "type" : "article-journal", "volume" : "222" }, "uris" : [ "http://www.mendeley.com/documents/?uuid=207ff7b6-7a08-4012-8731-e5469bcb32cd" ] } ], "mendeley" : { "formattedCitation" : "180,181", "plainTextFormattedCitation" : "180,181", "previouslyFormattedCitation" : "180,181" }, "properties" : { }, "schema" : "https://github.com/citation-style-language/schema/raw/master/csl-citation.json" }180,181 A strict indication should, therefore, be followed in order to achieve safe long-term EVAR outcomes. In cases of questionable anatomic suitability, alternative treatment strategies (e.g., open repair, and advanced endovascular repair with fenestrated or chimney grafts) should be considered instead of standard EVAR.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1583/1545-1550-20.2.159", "ISBN" : "1545-1550 (Electronic)\r1526-6028 (Linking)", "PMID" : "23581756", "abstract" : "PURPOSE: To review the literature reporting open surgical and endovascular treatment of juxtarenal aortic aneurysm (JAA). METHODS: A systematic search of the PubMed database was carried out to identify English-language articles published between January 2001 and July 2012 on the management of JAA with open surgery, fenestrated endovascular aneurysm repair (F-EVAR), and the chimney graft technique (Ch-EVAR). The search found 20 studies with a total of 1725 patients (76% men; age range 66-74 years) undergoing open surgery, 10 studies detailing 931 patients (87.6% men; age range 72-75 years) receiving F-EVAR, and 5 studies comprising 94 patients (75% men; age range 68-82) reporting Ch-EVAR. RESULTS: A total of 2465 vessels were targeted with fenestrations and 151 with chimney grafts (CG); intraoperative target vessel preservation was 98.6% and 98.0%, respectively. Cumulative 30-day mortality was 3.4%, 2.4%, and 5.3% for open surgery, F-EVAR and Ch-EVAR, respectively (p=NS). Impaired renal function was noted in 18.5%, 9.8%, and 12% following open surgery, F-EVAR, and Ch-EVAR, respectively (open vs. F-EVAR: p<0.001). New-onset dialysis was required postoperatively in 3.9%, 1.5%, and 2.1%, respectively (open vs. F-EVAR: p<0.001). Postoperative cardiac complications were noted in 11.3%, 3.7%, and 7.4%, respectively (open vs. F-EVAR: p<0.001). The incidence of ischemic stroke was 0.1% and 0.3% following open surgery and F-EVAR, but 3.2% after Ch-EVAR (open vs. Ch-EVAR: p=0.002; F-EVAR vs. Ch-EVAR: p=0.012). Early proximal type I endoleak was lower after F-EVAR compared to Ch-EVAR (4.3% vs. 10%, respectively, p=0.002). CONCLUSION: Open surgery remains a safe and effective treatment option for good risk patients with JAA. F-EVAR is associated with low operative mortality, compares favorably to open surgery in terms of morbidity, and current midterm data indicate that it can be a valid treatment option in both low- and high-risk patients. Early results of Ch-EVAR demonstrate feasibility only. In view of the limited number of reports and the lack of long-term data, the technique should be considered only in acute poor surgical risk patients, as a bailout in case of unintentional renal artery coverage, or in elective poor surgical cases that are not suitable for F-EVAR.", "author" : [ { "dropping-particle" : "", "family" : "Katsargyris", "given" : "A", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Oikonomou", "given" : "K", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Klonaris", "given" : "C", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Topel", "given" : "I", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Verhoeven", "given" : "E L", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "J Endovasc Ther", "id" : "ITEM-1", "issue" : "2", "issued" : { "date-parts" : [ [ "2013" ] ] }, "note" : "Katsargyris, Athanasios\nOikonomou, Kyriakos\nKlonaris, Chris\nTopel, Ingolf\nVerhoeven, Eric L G\neng\nReview\n2013/04/16 06:00\nJ Endovasc Ther. 2013 Apr;20(2):159-69. doi: 10.1583/1545-1550-20.2.159.", "page" : "159-169", "title" : "Comparison of outcomes with open, fenestrated, and chimney graft repair of juxtarenal aneurysms: are we ready for a paradigm shift?", "type" : "article-journal", "volume" : "20" }, "uris" : [ "http://www.mendeley.com/documents/?uuid=bbeb16b7-818d-44f3-88be-76fd59177cfe" ] } ], "mendeley" : { "formattedCitation" : "182", "plainTextFormattedCitation" : "182", "previouslyFormattedCitation" : "182" }, "properties" : { }, "schema" : "https://github.com/citation-style-language/schema/raw/master/csl-citation.json" }182
In 2013 a new concept of endovascular AAA repair (endovascular aneurysms sealing; EVAS) was introduced consisting of a combination of stent-grafts and polymer-filled endobags that fill the aneurysm sac aiming to minimize the risk for endoleaks. Clinical experience with EVAS up to now has shown that endobags can help to reduce type II endoleaks (back bleeding in the aneurysm sac from lumbar arteries or other side branches of the aorta) and associated reinterventions. Nevertheless, anchoring of the endobags on sac ILT may sometimes be unstable especially in AAAs with increased ILT burden, or in very large AAA due to smaller size of the endobags leading to stent-graft migration. Migration following EVAS proved to be a major issue that led to revision of the instructions for use in 2016, excluding AAAs with a specific amount of sac thrombus. Currently only mid-term follow-up data are available for EVAS.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1177/1526602816664365", "ISSN" : "1545-1550", "PMID" : "27555430", "abstract" : "PURPOSE To report the early and 12-month results of a global registry of patients treated with endovascular aneurysm sealing (EVAS) for abdominal aortic aneurysms (AAAs). METHODS The EVAS FORWARD Global Registry was a postmarket, multicenter, open-label, single-arm registry that enrolled 277 patients (mean age 75 years; 228 men) treated with the Nellix EVAS system for nonruptured AAAs at 18 sites over a 1-year period. The cohort had challenging aortic anatomy, with 17% having a proximal aortic neck length <10 mm, 8% a neck angulation >60\u00b0, and 20% an iliac diameter >25 mm. Baseline and follow-up computed tomography images were assessed by an independent core laboratory, and major adverse events were reviewed by an independent safety committee. RESULTS Three patients died within 30 days of the procedure (none device-related). There were 13 endoleaks recorded in this time frame: 8 type Ia, 1 type Ib, and 5 type II. Root cause analysis demonstrated that the majority of type Ia endoleaks were due to technical error (low device placement and underfilling of the endobags). Between 30 days and 1 year, there were 4 new type Ia endoleaks; all were treated. There was also 1 type III endoleak between a Nellix device and a distal extension limb. At 1 year, the persistent endoleak rate was 0.7% (1 type Ia and 1 type II). The Kaplan-Meier estimates of freedom from types I and II endoleak at 12-month follow-up were 96% and 98%, respectively. The estimate of freedom from open conversion (n=7) was 98% at 12 months and the rate of freedom from any reintervention was 92%. The need for secondary intervention was associated with aortic morphology; for patients meeting the requirements of the instructions for use (IFU), the freedom from reintervention at 12 months was 98% compared with 86% when the implant was outside the IFU (p=0.009). At 1 year, the estimates of freedom from aortic-related and all-cause mortality were 98% and 95%, respectively. CONCLUSION The EVAS FORWARD Global Registry documents the 12-month outcome of EVAS in an unselected group of patients with challenging aortic morphology. The results at present appear acceptable with regard to perioperative outcomes and complications. The type II endoleak rate is low. The place of EVAS in the armamentarium of techniques to treat AAAs will be defined by durability data in the longer term.", "author" : [ { "dropping-particle" : "", "family" : "Thompson", "given" : "Matt M", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Heyligers", "given" : "Jan M", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Hayes", "given" : "Paul D", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Reijnen", "given" : "Michel M P J", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "B\u00f6ckler", "given" : "Dittmar", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Schelzig", "given" : "Hubert", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Vries", "given" : "Jean-Paul P M", "non-dropping-particle" : "de", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Krievins", "given" : "Dainis", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Holden", "given" : "Andrew", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "EVAS FORWARD Global Registry Investigators", "given" : "", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Journal of endovascular therapy : an official journal of the International Society of Endovascular Specialists", "id" : "ITEM-1", "issue" : "5", "issued" : { "date-parts" : [ [ "2016", "10", "22" ] ] }, "page" : "685-92", "title" : "Endovascular Aneurysm Sealing: Early and Midterm Results From the EVAS FORWARD Global Registry.", "type" : "article-journal", "volume" : "23" }, "uris" : [ "http://www.mendeley.com/documents/?uuid=609dcebd-1110-37e7-88c2-74100fb96705" ] } ], "mendeley" : { "formattedCitation" : "183", "plainTextFormattedCitation" : "183", "previouslyFormattedCitation" : "183" }, "properties" : { }, "schema" : "https://github.com/citation-style-language/schema/raw/master/csl-citation.json" }183 Based on what we learnt from the long-term follow-up of the EVAR trials, the long-term durability of a treatment modality maybe more important than early technical success. Table 2 summarizes the most common complications that can occur after EVAR and open surgical AAA repair.
[H2] Non-surgical treatment
When surgical or endovascular treatment is not applicable, AAA progression with increasing diameter and rupture risk is inevitable. Medical treatment to prevent AAA progression could have a significant impact on the management of patients with AAA.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1016/j.ejvs.2007.03.006", "ISBN" : "1078-5884 (Print)\r1078-5884 (Linking)", "PMID" : "17540588", "abstract" : "Medical management of patients with abdominal aortic aneurysm (AAA) is required for several different reasons. Since these patients have an increased risk of cardiovascular death therapy to reduce cardiovascular events is essential. Treatment is in line with the medical management of coronary artery disease including smoking cessation, statins and anti-platelet therapy. Some of these therapies also will slow aneurysm growth. Currently there is no proven focused therapy that reduces aneurysm growth, but the emerging strategies are discussed. Medical management also is required to reduce peri-operative risks and stabilise endovascular aneurysm repair. Whilst some of the therapies targeting cardiovascular risk reduction may be helpful, other emerging strategies are discussed.", "author" : [ { "dropping-particle" : "", "family" : "Golledge", "given" : "J", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Powell", "given" : "J T", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Eur J Vasc Endovasc Surg", "id" : "ITEM-1", "issue" : "3", "issued" : { "date-parts" : [ [ "2007" ] ] }, "note" : "Golledge, J\nPowell, J T\neng\nR01 HL080010-01/HL/NHLBI NIH HHS/\nCase Reports\nResearch Support, N.I.H., Extramural\nResearch Support, Non-U.S. Gov't\nReview\nEngland\n2007/06/02 09:00\nEur J Vasc Endovasc Surg. 2007 Sep;34(3):267-73. doi: 10.1016/j.ejvs.2007.03.006. Epub 2007 May 30.", "page" : "267-273", "title" : "Medical management of abdominal aortic aneurysm", "type" : "article-journal", "volume" : "34" }, "uris" : [ "http://www.mendeley.com/documents/?uuid=36f16a03-49a4-44df-9d3e-9f7ded4a9ccb" ] }, { "id" : "ITEM-2", "itemData" : { "DOI" : "10.1161/CIRCULATIONAHA.107.735274", "ISBN" : "1524-4539 (Electronic)\r0009-7322 (Linking)", "PMID" : "18391122", "abstract" : "Abdominal aortic aneurysm is a common condition that may be lethal when it is unrecognized. Current guidelines suggest repair as the aneurysm diameter reaches 5.0 to 5.5 cm. Most aortic aneurysms are detected incidentally when imaging is done for other purposes or through screening programs. Ninety percent of these aneurysms are below the threshold for intervention at the time of detection. A number of studies have sought to determine factors that lead to progression of aneurysmal disease that might be amenable to intervention during this period of observation. We review these studies and make recommendations for the medical management of small abdominal aortic aneurysms. On the basis of our current knowledge of the causes of aneurysm, a number of approaches have been proposed to prevent progression of aneurysmal disease. These include hemodynamic management, inhibition of inflammation, and protease inhibition. The American College of Cardiology/American Heart Association clinical practice guidelines rules of evidence have helped to define strength of evidence to support these approaches. Level A evidence (from large randomized trials) is available to indicate that observation of small aneurysms in men is safe up to a size of 5.5 cm and that propranolol does not inhibit aneurysm expansion. Level B evidence (from small randomized trials) suggests that roxithromycin or doxycycline will decrease the rate of aneurysm expansion. A number of studies agree that tobacco use is associated with an increased rate of aneurysm expansion. Level B and C evidence is available to suggest that 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors (statins) may inhibit aneurysm expansion. There are animal data but no human data demonstrating that angiotensin-converting enzyme inhibitors or losartan, an angiotensin receptor blocker, will decrease the rate of AAA expansion. A pharmacological agent without important side effects that inhibited aneurysm expansion could change current approaches to aneurysm treatment. Additional studies are needed to clarify the potential role of doxycycline, roxithromycin, and statin therapy in the progression of aneurysmal disease.", "author" : [ { "dropping-particle" : "", "family" : "Baxter", "given" : "B T", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Terrin", "given" : "M C", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Dalman", "given" : "R L", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Circulation", "id" : "ITEM-2", "issue" : "14", "issued" : { "date-parts" : [ [ "2008" ] ] }, "note" : "Baxter, B Timothy\nTerrin, Michael C\nDalman, Ronald L\neng\nR01 HL064338-08W1/HL/NHLBI NIH HHS/\n2R0-1HL092400-06/HL/NHLBI NIH HHS/\nP30 AG028747-04/AG/NIA NIH HHS/\nR01 HL064338/HL/NHLBI NIH HHS/\nP30 AG028747/AG/NIA NIH HHS/\nR01 HL064338-06/HL/NHLBI NIH HHS/\nR34 AG028684-01A1/AG/NIA NIH HHS/\nR01 HL062400-06/HL/NHLBI NIH HHS/\nP50 HL083800-010003/HL/NHLBI NIH HHS/\nR01 HL062400/HL/NHLBI NIH HHS/\nP30 AG028747-05/AG/NIA NIH HHS/\nP50 HL083800/HL/NHLBI NIH HHS/\nR34 AG028684/AG/NIA NIH HHS/\nP50 HL083800-01/HL/NHLBI NIH HHS/\n1 P50 HL 83800-01/HL/NHLBI NIH HHS/\nResearch Support, N.I.H., Extramural\nResearch Support, Non-U.S. Gov't\nReview\n2008/04/09 09:00\nCirculation. 2008 Apr 8;117(14):1883-9. doi: 10.1161/CIRCULATIONAHA.107.735274.", "page" : "1883-1889", "title" : "Medical management of small abdominal aortic aneurysms", "type" : "article-journal", "volume" : "117" }, "uris" : [ "http://www.mendeley.com/documents/?uuid=ef4260e8-71ba-4297-b269-b7098314bef2" ] }, { "id" : "ITEM-3", "itemData" : { "author" : [ { "dropping-particle" : "", "family" : "Yoshimura", "given" : "K", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Aoki", "given" : "H", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Ikeda", "given" : "Y", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Furutani", "given" : "A", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Hamano", "given" : "K", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Matsuzaki", "given" : "M", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Aortic aneurysms: new insights into an old problem", "edition" : "Edition de", "editor" : [ { "dropping-particle" : "", "family" : "Sakalihasan", "given" : "N", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Kuivaniemi", "given" : "H", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Michel", "given" : "J B", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "id" : "ITEM-3", "issued" : { "date-parts" : [ [ "2008" ] ] }, "page" : "453-76", "title" : "Development of pharmacological therapy for abdominal aortic aneurysms based on animal studies", "type" : "chapter" }, "uris" : [ "http://www.mendeley.com/documents/?uuid=6f596620-fe78-40e7-bfec-0a5f7d931a22" ] }, { "id" : "ITEM-4", "itemData" : { "DOI" : "10.1016/j.jvs.2016.08.003", "ISBN" : "1097-6809 (Electronic)\r0741-5214 (Linking)", "PMID" : "27641464", "abstract" : "OBJECTIVE: This review describes ongoing efforts to develop a medical therapy to limit abdominal aortic aneurysm (AAA) growth. METHODS: Data from animal model studies, human investigations, and clinical trials are described. RESULTS: Studies in rodent models and human samples have suggested a number of potential targets for slowing or halting AAA growth. A number of clinical trials are now examining the value of medications targeting some of the pathways identified. These trials have a number of challenges, including identifying medications safe to use in older patients with multiple comorbidities, developing accurate outcome assessments, and minimizing the dropout of patients during the trials. Three recent trials have reported no benefit of the antibiotic doxycycline, a mast cell inhibitor, an angiotensin-converting enzyme inhibitor, or a calcium channel blocker in limiting AAA growth. A number of other trials examining angiotensin receptor blockers, cyclosporine, and an antiplatelet agent are currently underway. CONCLUSIONS: Further refinement of drug discovery pathways and testing paradigms are likely needed to develop effective nonsurgical therapies for AAA.", "author" : [ { "dropping-particle" : "", "family" : "Golledge", "given" : "J", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Norman", "given" : "P E", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Murphy", "given" : "M P", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Dalman", "given" : "R L", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "J Vasc Surg", "id" : "ITEM-4", "issue" : "1", "issued" : { "date-parts" : [ [ "2017" ] ] }, "note" : "Golledge, Jonathan\nNorman, Paul E\nMurphy, Michael P\nDalman, Ronald L\neng\nReview\n2016/09/20 06:00\nJ Vasc Surg. 2017 Jan;65(1):225-233. doi: 10.1016/j.jvs.2016.08.003. Epub 2016 Sep 15.", "page" : "225-233", "title" : "Challenges and opportunities in limiting abdominal aortic aneurysm growth", "type" : "article-journal", "volume" : "65" }, "uris" : [ "http://www.mendeley.com/documents/?uuid=5d262c36-f7d0-4794-bd46-46114ae34121" ] }, { "id" : "ITEM-5", "itemData" : { "DOI" : "10.2174/1389450119666171227223331", "ISBN" : "1873-5592 (Electronic)\r1389-4501 (Linking)", "PMID" : "29284386", "abstract" : "Abdominal aortic aneurysm (AAA), a common disease involving the segmental expansion and rupture of the aorta, has a high mortality rate. Therapeutic options for AAA are currently limited to surgical repair to prevent catastrophic rupture. Non-surgical approaches, particularly pharmacotherapy, are lacking for the treatment of AAA. Here, we review both basic and clinical studies and discuss the current challenges to developing medical therapy that reduces AAA progression. Studies using animal models of AAA progression and human AAA explant cultures have identified several potential targets for preventing AAA growth. However, no clinical studies have convincingly confirmed the efficacy of any pharmacologic treatment against the growth of AAA. Thus, there is as yet no strong recommendation regarding pharmacotherapy to reduce the risk of AAA progression and rupture. This review identifies concerns that need to be addressed for the field to progress and discusses the challenges that must be overcome in order to develop effective pharmacotherapy to reduce AAA progression in the future.", "author" : [ { "dropping-particle" : "", "family" : "Yoshimura", "given" : "K", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Morikage", "given" : "N", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Nishino-Fujimoto", "given" : "S", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Furutani", "given" : "A", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Shirasawa", "given" : "B", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Hamano", "given" : "K", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Curr Drug Targets", "id" : "ITEM-5", "issued" : { "date-parts" : [ [ "2017" ] ] }, "note" : "Yoshimura, Koichi\nMorikage, Noriyasu\nNishino-Fujimoto, Shizuka\nFurutani, Akira\nShirasawa, Bungo\nHamano, Kimikazu\neng\nNetherlands\n2017/12/30 06:00\nCurr Drug Targets. 2017 Dec 27. pii: CDT-EPUB-87605. doi: 10.2174/1389450119666171227223331.", "title" : "Current Status and Perspectives on Pharmacologic Therapy for Abdominal Aortic Aneurysm", "type" : "article-journal" }, "uris" : [ "http://www.mendeley.com/documents/?uuid=63fb58d8-47ab-429e-a414-39b0fe1fc2b3" ] } ], "mendeley" : { "formattedCitation" : "184\u2013188", "plainTextFormattedCitation" : "184\u2013188", "previouslyFormattedCitation" : "184\u2013188" }, "properties" : { }, "schema" : "https://github.com/citation-style-language/schema/raw/master/csl-citation.json" }184188
[ [H3] Non-surgical therapy in experimental studies The progression of a preexisting AAA in small animal models can be suppressed by pharmacologic intervention.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1016/j.jvs.2016.08.003", "ISBN" : "1097-6809 (Electronic)\r0741-5214 (Linking)", "PMID" : "27641464", "abstract" : "OBJECTIVE: This review describes ongoing efforts to develop a medical therapy to limit abdominal aortic aneurysm (AAA) growth. METHODS: Data from animal model studies, human investigations, and clinical trials are described. RESULTS: Studies in rodent models and human samples have suggested a number of potential targets for slowing or halting AAA growth. A number of clinical trials are now examining the value of medications targeting some of the pathways identified. These trials have a number of challenges, including identifying medications safe to use in older patients with multiple comorbidities, developing accurate outcome assessments, and minimizing the dropout of patients during the trials. Three recent trials have reported no benefit of the antibiotic doxycycline, a mast cell inhibitor, an angiotensin-converting enzyme inhibitor, or a calcium channel blocker in limiting AAA growth. A number of other trials examining angiotensin receptor blockers, cyclosporine, and an antiplatelet agent are currently underway. CONCLUSIONS: Further refinement of drug discovery pathways and testing paradigms are likely needed to develop effective nonsurgical therapies for AAA.", "author" : [ { "dropping-particle" : "", "family" : "Golledge", "given" : "J", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Norman", "given" : "P E", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Murphy", "given" : "M P", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Dalman", "given" : "R L", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "J Vasc Surg", "id" : "ITEM-1", "issue" : "1", "issued" : { "date-parts" : [ [ "2017" ] ] }, "note" : "Golledge, Jonathan\nNorman, Paul E\nMurphy, Michael P\nDalman, Ronald L\neng\nReview\n2016/09/20 06:00\nJ Vasc Surg. 2017 Jan;65(1):225-233. doi: 10.1016/j.jvs.2016.08.003. Epub 2016 Sep 15.", "page" : "225-233", "title" : "Challenges and opportunities in limiting abdominal aortic aneurysm growth", "type" : "article-journal", "volume" : "65" }, "uris" : [ "http://www.mendeley.com/documents/?uuid=5d262c36-f7d0-4794-bd46-46114ae34121" ] }, { "id" : "ITEM-2", "itemData" : { "DOI" : "10.2174/1389450119666171227223331", "ISBN" : "1873-5592 (Electronic)\r1389-4501 (Linking)", "PMID" : "29284386", "abstract" : "Abdominal aortic aneurysm (AAA), a common disease involving the segmental expansion and rupture of the aorta, has a high mortality rate. Therapeutic options for AAA are currently limited to surgical repair to prevent catastrophic rupture. Non-surgical approaches, particularly pharmacotherapy, are lacking for the treatment of AAA. Here, we review both basic and clinical studies and discuss the current challenges to developing medical therapy that reduces AAA progression. Studies using animal models of AAA progression and human AAA explant cultures have identified several potential targets for preventing AAA growth. However, no clinical studies have convincingly confirmed the efficacy of any pharmacologic treatment against the growth of AAA. Thus, there is as yet no strong recommendation regarding pharmacotherapy to reduce the risk of AAA progression and rupture. This review identifies concerns that need to be addressed for the field to progress and discusses the challenges that must be overcome in order to develop effective pharmacotherapy to reduce AAA progression in the future.", "author" : [ { "dropping-particle" : "", "family" : "Yoshimura", "given" : "K", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Morikage", "given" : "N", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Nishino-Fujimoto", "given" : "S", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Furutani", "given" : "A", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Shirasawa", "given" : "B", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Hamano", "given" : "K", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Curr Drug Targets", "id" : "ITEM-2", "issued" : { "date-parts" : [ [ "2017" ] ] }, "note" : "Yoshimura, Koichi\nMorikage, Noriyasu\nNishino-Fujimoto, Shizuka\nFurutani, Akira\nShirasawa, Bungo\nHamano, Kimikazu\neng\nNetherlands\n2017/12/30 06:00\nCurr Drug Targets. 2017 Dec 27. pii: CDT-EPUB-87605. doi: 10.2174/1389450119666171227223331.", "title" : "Current Status and Perspectives on Pharmacologic Therapy for Abdominal Aortic Aneurysm", "type" : "article-journal" }, "uris" : [ "http://www.mendeley.com/documents/?uuid=63fb58d8-47ab-429e-a414-39b0fe1fc2b3" ] }, { "id" : "ITEM-3", "itemData" : { "DOI" : "10.1161/ATVBAHA.116.308534", "ISSN" : "1079-5642", "PMID" : "28062500", "abstract" : "Human abdominal aortic aneurysm (AAA) pathophysiology is not yet completely understood. In conductance arteries, the insoluble extracellular matrix, synthesized by vascular smooth muscle cells, assumes the function of withstanding the intraluminal arterial blood pressure. Progressive loss of this function through extracellular matrix proteolysis is a main feature of AAAs. As most patients are now treated via endovascular approaches, surgical AAA specimens have become rare. Animal models provide valuable complementary insights into AAA pathophysiology. Current experimental AAA models involve induction of intraluminal dilation (nondissecting AAAs) or a contained intramural rupture (dissecting models). Although the ideal model should reproduce the histological characteristics and natural history of the human disease, none of the currently available animal models perfectly do so. Experimental models try to represent the main pathophysiological determinants of AAAs: genetic or acquired defects in extracellular matrix, loss of vascular smooth muscle cells, and innate or adaptive immune response. Nevertheless, most models are characterized by aneurysmal stabilization and healing after a few weeks because of cessation of the initial stimulus. Recent studies have focused on ways to optimize existing models to allow continuous aneurysmal growth. This review aims to discuss the relevance and recent advances of current animal AAA models. VISUAL OVERVIEW An online visual overview is available for this article.", "author" : [ { "dropping-particle" : "", "family" : "S\u00e9n\u00e9maud", "given" : "Jean", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Caligiuri", "given" : "Giuseppina", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Etienne", "given" : "Harry", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Delbosc", "given" : "Sandrine", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Michel", "given" : "Jean-Baptiste", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Coscas", "given" : "Rapha\u00ebl", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Arteriosclerosis, Thrombosis, and Vascular Biology", "id" : "ITEM-3", "issue" : "3", "issued" : { "date-parts" : [ [ "2017", "3" ] ] }, "page" : "401-410", "title" : "Translational Relevance and Recent Advances of Animal Models of Abdominal Aortic AneurysmHighlights", "type" : "article-journal", "volume" : "37" }, "uris" : [ "http://www.mendeley.com/documents/?uuid=650f45f9-5848-3598-8a27-219d0f06932e" ] }, { "id" : "ITEM-4", "itemData" : { "DOI" : "10.1016/j.ejvs.2016.07.004", "ISSN" : "10785884", "author" : [ { "dropping-particle" : "", "family" : "Lysgaard Poulsen", "given" : "J.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Stubbe", "given" : "J.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Lindholt", "given" : "J.S.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "European Journal of Vascular and Endovascular Surgery", "id" : "ITEM-4", "issue" : "4", "issued" : { "date-parts" : [ [ "2016", "10" ] ] }, "page" : "487-499", "title" : "Animal Models Used to Explore Abdominal Aortic Aneurysms: A Systematic Review", "type" : "article-journal", "volume" : "52" }, "uris" : [ "http://www.mendeley.com/documents/?uuid=0df1c88d-a1bf-3d71-81c7-fed2627c0273" ] }, { "id" : "ITEM-5", "itemData" : { "DOI" : "10.1016/j.carpath.2010.01.001", "ISSN" : "1879-1336", "PMID" : "20133168", "abstract" : "Abdominal aortic aneurysm is a common degenerative disorder associated with sudden death due to aortic rupture. Current therapy is limited to open surgical repair of the aorta or endovascular placement of covered stents to exclude the abdominal aortic aneurysm from the circulation. A number of different animal models have been developed in order to study abdominal aortic aneurysm in an effort to advance current management deficiencies. Large animal models have been mostly used to assist in developing novel methods to surgically treat abdominal aortic aneurysms. Small animal models, particularly those developed in rodents, have been employed to further the understanding of the mechanisms involved in abdominal aortic aneurysm in order to identify potential new medical treatments. It is expected that findings from these animal models will contribute importantly to new treatments for human abdominal aortic aneurysm. This review explores the animal models which are used in abdominal aortic aneurysm research and highlights their advantages and disadvantages.", "author" : [ { "dropping-particle" : "", "family" : "Trollope", "given" : "Alexandra", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "V", "family" : "Moxon", "given" : "Joseph", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Moran", "given" : "Corey S", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Golledge", "given" : "Jonathan", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Cardiovascular pathology : the official journal of the Society for Cardiovascular Pathology", "id" : "ITEM-5", "issue" : "2", "issued" : { "date-parts" : [ [ "2011", "3" ] ] }, "page" : "114-23", "title" : "Animal models of abdominal aortic aneurysm and their role in furthering management of human disease.", "type" : "article-journal", "volume" : "20" }, "uris" : [ "http://www.mendeley.com/documents/?uuid=415c3e54-7a71-3f04-aa2c-9b54dcb41c42" ] } ], "mendeley" : { "formattedCitation" : "96,187\u2013190", "plainTextFormattedCitation" : "96,187\u2013190", "previouslyFormattedCitation" : "96,187\u2013190" }, "properties" : { }, "schema" : "https://github.com/citation-style-language/schema/raw/master/csl-citation.json" }96,187190 More specifically, effectiveness of interventions to regulate proinflammatory mediators, renin-angiotensin system and prostaglandin metabolism on progression of preexisting AAA has been demonstrated. Interventions to inhibit inflammatory signaling pathways, and treatments with immunosuppressive agents are also effective in halting AAA progression. Notably, treatment with c-Jun N-terminal kinase (JNK) inhibitor after establishment of AAA formation resulted in a reduction of the aneurysm diameter.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "1085/1/74 [pii] 10.1196/annals.1383.031", "ISBN" : "0077-8923 (Print) 0077-8923 (Linking)", "PMID" : "17182924", "abstract" : "Abdominal aortic aneurysm (AAA) is a common disease that, when surgical treatment is inapplicable, results in rupture of the aorta with high mortality. Although nonsurgical treatment for AAA is eagerly awaited, the destruction of the aortic walls in AAA has been considered an irreversible process. We found that c-Jun N-terminal kinase (JNK) is highly activated in human AAA walls. We also found that JNK activity is essential for the expression of matrix metalloproteinase (MMP)-9 and, concurrently, suppression of the extracellular matrix (ECM) biosynthesis. We therefore investigated the role of JNK in the pathogenesis of AAA in vivo. We created a mouse AAA model by periaortic application of CaCl(2), which was accompanied by activation of JNK and MMPs, and suppression of lysyl oxidase (LOX), which is an essential biosynthetic enzyme for collagen and elastin fibers. Our data indicate that, in addition to MMP activities, suppression of ECM biosynthesis may contribute to the AAA pathogenesis because local LOX gene delivery prevented AAA formation. Treatment of mice with SP600125, a specific JNK inhibitor, completely abrogated the formation of CaCl(2)-induced AAA. Furthermore, SP600125 treatment after the establishment of AAA caused a reduction in the aortic diameters with normalized tissue architecture. SP600125 treatment also caused significant regression of angiotensin II-induced AAA in ApoE-null mice after its establishment, as demonstrated by serial ultrasonographic studies in live animals. These data demonstrate that JNK dictates the abnormal ECM metabolism in AAA pathogenesis by enhancing tissue degradation and suppressing tissue repair. Therefore, inhibition of JNK may provide a novel therapeutic option for AAA.", "author" : [ { "dropping-particle" : "", "family" : "Yoshimura", "given" : "K", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Aoki", "given" : "H", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Ikeda", "given" : "Y", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Furutani", "given" : "A", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Hamano", "given" : "K", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Matsuzaki", "given" : "M", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Ann N Y Acad Sci", "edition" : "2006/12/22", "id" : "ITEM-1", "issued" : { "date-parts" : [ [ "2006" ] ] }, "language" : "eng", "note" : "Yoshimura, Koichi\nAoki, Hiroki\nIkeda, Yasuhiro\nFurutani, Akira\nHamano, Kimikazu\nMatsuzaki, Masunori\nResearch Support, Non-U.S. Gov't\nUnited States\nAnnals of the New York Academy of Sciences\nAnn N Y Acad Sci. 2006 Nov;1085:74-81.", "page" : "74-81", "title" : "Regression of abdominal aortic aneurysm by inhibition of c-Jun N-terminal kinase in mice", "type" : "article-journal", "volume" : "1085" }, "uris" : [ "http://www.mendeley.com/documents/?uuid=9ea643e8-84b7-4ecc-86de-55ef101a7c6e" ] } ], "mendeley" : { "formattedCitation" : "191", "plainTextFormattedCitation" : "191", "previouslyFormattedCitation" : "191" }, "properties" : { }, "schema" : "https://github.com/citation-style-language/schema/raw/master/csl-citation.json" }191Abrogating ECM degradation by using MMP inhibitors can also be effective in preventing AAA progression. Because of the considerable differences in the AAA pathophysiology of humans and animal models, effectiveness of pharmacological interventions has also been studied using human AAA explant culture.
Indeed, interventions to regulate inflammatory responses and treatments with MMP inhibitors are reported to be effective in ex vivo culture of human AAA tissues. Treatment with HMG-CoA reductase inhibitors (statins) or angiotensin-converting enzyme (ACE) inhibitors was also effective in reducing inflammatory responses in human AAA tissue culture.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.2174/1389450119666171227223331", "ISBN" : "1873-5592 (Electronic)\r1389-4501 (Linking)", "PMID" : "29284386", "abstract" : "Abdominal aortic aneurysm (AAA), a common disease involving the segmental expansion and rupture of the aorta, has a high mortality rate. Therapeutic options for AAA are currently limited to surgical repair to prevent catastrophic rupture. Non-surgical approaches, particularly pharmacotherapy, are lacking for the treatment of AAA. Here, we review both basic and clinical studies and discuss the current challenges to developing medical therapy that reduces AAA progression. Studies using animal models of AAA progression and human AAA explant cultures have identified several potential targets for preventing AAA growth. However, no clinical studies have convincingly confirmed the efficacy of any pharmacologic treatment against the growth of AAA. Thus, there is as yet no strong recommendation regarding pharmacotherapy to reduce the risk of AAA progression and rupture. This review identifies concerns that need to be addressed for the field to progress and discusses the challenges that must be overcome in order to develop effective pharmacotherapy to reduce AAA progression in the future.", "author" : [ { "dropping-particle" : "", "family" : "Yoshimura", "given" : "K", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Morikage", "given" : "N", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Nishino-Fujimoto", "given" : "S", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Furutani", "given" : "A", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Shirasawa", "given" : "B", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Hamano", "given" : "K", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Curr Drug Targets", "id" : "ITEM-1", "issued" : { "date-parts" : [ [ "2017" ] ] }, "note" : "Yoshimura, Koichi\nMorikage, Noriyasu\nNishino-Fujimoto, Shizuka\nFurutani, Akira\nShirasawa, Bungo\nHamano, Kimikazu\neng\nNetherlands\n2017/12/30 06:00\nCurr Drug Targets. 2017 Dec 27. pii: CDT-EPUB-87605. doi: 10.2174/1389450119666171227223331.", "title" : "Current Status and Perspectives on Pharmacologic Therapy for Abdominal Aortic Aneurysm", "type" : "article-journal" }, "uris" : [ "http://www.mendeley.com/documents/?uuid=63fb58d8-47ab-429e-a414-39b0fe1fc2b3" ] } ], "mendeley" : { "formattedCitation" : "188", "plainTextFormattedCitation" : "188", "previouslyFormattedCitation" : "188" }, "properties" : { }, "schema" : "https://github.com/citation-style-language/schema/raw/master/csl-citation.json" }188
In addition, cell therapy has also been suggested to be useful in preventing AAA progression. Local infusion of bone marrow-derived mesenchymal stem cells (BM-MSCs), endothelial cells or VSMCs, as well as systemic injection of BM-MSCs, was shown to be effective in suppressing the progression of preexisting AAA in animal models.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "ISBN" : "0003-4932 (Print)\r0003-4932 (Linking)", "PMID" : "15075661", "abstract" : "OBJECTIVE: To investigate the efficiency of endovascular smooth muscle cell (VSMC) seeding in promoting healing and stability in already-developed aneurysms obtained by matrix metalloproteases (MMPs)-driven injury. SUMMARY BACKGROUND DATA: VSMCs are instrumental in arterial healing after injury and are in decreased number in arterial aneurysms. This cellular deficiency may account for poor healing capabilities and ongoing expansion of aneurysms. METHODS: Aneurysmal aortic xenografts in rats displaying extracellular matrix injury by inflammation and proteolysis were seeded endoluminally with syngeneic VSMCs, with controls receiving culture medium only. Diameter, structure, and the destruction/reconstruction balance were assessed. RESULTS: Eight weeks after endovascular infusion, aneurysmal diameter had increased further, from 3.0 +/- 0.3 mm to 10.9 +/- 6.5 mm (P = 0.009), and medial elastin content had decreased from 36.5 +/- 8.5 to 5.2 +/- 5.5 surface-percent (S%; P = 0.009) in controls, whereas these parameters remained stable in the seeded group (3.0 +/- 0.3 to 2.7 +/- 0.2 mm, P = 0.08; 36.5 +/- 8.4 to 31.6 +/- 9.7 S%, P = 0.22). VSMC seeding was followed by a decrease in mononuclear infiltration. MMP-1, -3, -7, -9, and -12 mRNA contents were sharply decreased in the diseased wall in response to seeding. Tissue inhibitor of metalloproteinase-1, -2, and -3 mRNAs in the intima were increased in a 2 to 10 magnitude in comparison with controls. Gelatin zymography showed the disappearance of MMP-9 activity and reverse zymography a strong increase in tissue inhibitor of metalloproteinase-3 activity in the seeded group. VSMC-seeded aneurysms were rich in collagen and lined with an endothelium instead of a thrombus in controls. CONCLUSIONS: VSMCs endovascular seeding restores the healing capabilities of proteolytically injured extracellular matrix in aneurysmal aortas, and stops expansion.", "author" : [ { "dropping-particle" : "", "family" : "Allaire", "given" : "E", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Muscatelli-Groux", "given" : "B", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Guinault", "given" : "A M", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Pages", "given" : "C", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Goussard", "given" : "A", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Mandet", "given" : "C", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Bruneval", "given" : "P", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Melliere", "given" : "D", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Becquemin", "given" : "J P", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Ann Surg", "id" : "ITEM-1", "issue" : "3", "issued" : { "date-parts" : [ [ "2004" ] ] }, "note" : "Allaire, Eric\nMuscatelli-Groux, Beatrice\nGuinault, Anne-Marie\nPages, Carine\nGoussard, Audrey\nMandet, Chantal\nBruneval, Patrick\nMelliere, Didier\nBecquemin, Jean-Pierre\neng\nResearch Support, Non-U.S. Gov't\n2004/04/13 05:00\nAnn Surg. 2004 Mar;239(3):417-27.", "page" : "417-427", "title" : "Vascular smooth muscle cell endovascular therapy stabilizes already developed aneurysms in a model of aortic injury elicited by inflammation and proteolysis", "type" : "article-journal", "volume" : "239" }, "uris" : [ "http://www.mendeley.com/documents/?uuid=f02b73e9-c480-4f2b-99dd-67d4bd05af90" ] }, { "id" : "ITEM-2", "itemData" : { "DOI" : "10.1016/j.ejvs.2013.03.007", "ISBN" : "1532-2165 (Electronic)\r1078-5884 (Linking)", "PMID" : "23598054", "abstract" : "PURPOSE: Abdominal aortic aneurysms (AAAs) expand because of aortic wall destruction. Enrichment in Vascular Smooth Muscle Cells (VSMCs) stabilizes expanding AAAs in rats. Mesenchymal Stem Cells (MSCs) can differentiate into VSMCs. We have tested the hypothesis that bone marrow-derived MSCs (BM-MSCs) stabilizes AAAs in a rat model. MATERIAL AND METHODS: Rat Fischer 344 BM-MSCs were isolated by plastic adhesion and seeded endovascularly in experimental AAAs using xenograft obtained from guinea pig. Culture medium without cells was used as control group. The main criteria was the variation of the aortic diameter at one week and four weeks. We evaluated the impact of cells seeding on inflammatory response by immunohistochemistry combined with RT-PCR on MMP9 and TIMP1 at one week. We evaluated the healing process by immunohistochemistry at 4 weeks. RESULTS: The endovascular seeding of BM-MSCs decreased AAA diameter expansion more powerfully than VSMCs or culture medium infusion (6.5% +/- 9.7, 25.5% +/- 17.2 and 53.4% +/- 14.4; p = .007, respectively). This result was sustained at 4 weeks. BM-MSCs decreased expression of MMP-9 and infiltration by macrophages (4.7 +/- 2.3 vs. 14.6 +/- 6.4 mm(2) respectively; p = .015), increased Tissue Inhibitor Metallo Proteinase-1 (TIMP-1), compared to culture medium infusion. BM-MSCs induced formation of a neo-aortic tissue rich in SM-alpha active positive cells (22.2 +/- 2.7 vs. 115.6 +/- 30.4 cells/surface units, p = .007) surrounded by a dense collagen and elastin network covered by luminal endothelial cells. CONCLUSIONS: We have shown in this rat model of AAA that BM-MSCs exert a specialized function in arterial regeneration that transcends that of mature mesenchymal cells. Our observation identifies a population of cells easy to isolate and to expand for therapeutic interventions based on catheter-driven cell therapy.", "author" : [ { "dropping-particle" : "", "family" : "Schneider", "given" : "F", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Saucy", "given" : "F", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Blic", "given" : "R", "non-dropping-particle" : "de", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Dai", "given" : "J", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Mohand", "given" : "F", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Rouard", "given" : "H", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Ricco", "given" : "J B", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Becquemin", "given" : "J P", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Gervais", "given" : "M", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Allaire", "given" : "E", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Eur J Vasc Endovasc Surg", "id" : "ITEM-2", "issue" : "6", "issued" : { "date-parts" : [ [ "2013" ] ] }, "note" : "Schneider, F\nSaucy, F\nde Blic, R\nDai, J\nMohand, F\nRouard, H\nRicco, J-B\nBecquemin, J-P\nGervais, M\nAllaire, E\neng\nComparative Study\nResearch Support, Non-U.S. Gov't\nEngland\n2013/04/20 06:00\nEur J Vasc Endovasc Surg. 2013 Jun;45(6):666-72. doi: 10.1016/j.ejvs.2013.03.007. Epub 2013 Apr 15.", "page" : "666-672", "title" : "Bone marrow mesenchymal stem cells stabilize already-formed aortic aneurysms more efficiently than vascular smooth muscle cells in a rat model", "type" : "article-journal", "volume" : "45" }, "uris" : [ "http://www.mendeley.com/documents/?uuid=15eda248-c409-4dc9-b4c9-149d861f1fc1" ] }, { "id" : "ITEM-3", "itemData" : { "DOI" : "10.1093/ejcts/ezu018", "ISBN" : "1873-734X (Electronic)\r1010-7940 (Linking)", "PMID" : "24554076", "abstract" : "OBJECTIVES: An aortic aneurysm (AA) is caused by atherosclerosis with chronic inflammation. Mesenchymal stem cells (MSCs) have potential anti-inflammatory properties. In this study, we examined whether an already-formed AA can be treated by intravenous injection of bone marrow-derived (BM)-MSCs in a mouse model. METHODS: AA was induced in apolipoprotein E-deficient mice by angiotensin II-infusion for 28 days through sub-cutaneous osmotic mini-pumps. After that, 1 x 10(6) BM-MSCs (in 0.2 ml saline) or 0.2 ml saline as a control was injected via the tail vein. Mice were sacrificed at 2 (saline group n = 10, BM-MSC group n = 10), 4 (saline group n = 6, BM-MSC group n = 7) or 8 weeks (saline group n = 5, BM-MSC group n = 6) after injection. The aortic tissues of each group were dissected. Aortic diameter, elastin content, matrix metalloproteinase (MMP)-2 and -9 enzymatic activity and cytokine concentrations were measured, as was macrophage infiltration, which was also evaluated histologically. RESULTS: The incidence of AA in the BM-MSC group was reduced at 2 weeks (BM-MSC 40% vs saline 100%, P < 0.05), and aortic diameter was reduced at 2 and 4 weeks (2 weeks: 1.40 vs 2.29 mm, P < 0.001; 4 weeks: 1.73 vs 2.32 mm, P < 0.05). The enzymatic activities of MMP-2 and -9 were reduced in the BM-MSC group at 2 weeks (active-MMP-2: 0.28 vs 0.45 unit/ml, P < 0.05; active-MMP-9: 0.16 vs 0.34 unit/ml, P < 0.05). Inflammatory cytokines were down-regulated in the BM-MSC group (interleukin-6: 2 weeks: 1475.6 vs 3399.5 pg/ml, P < 0.05; 4 weeks: 2184.7 vs 3712.8 pg/ml, P < 0.05 and monocyte chemotactic protein-1: 2 weeks: 208.0 vs 352.7 pg/ml, P < 0.05) and insulin-like growth factor (IGF)-1 and tissue inhibitor of metalloproteinase (TIMP)-2 were up-regulated in the BM-MSC group at 2 weeks (IGF-1: 4.7 vs 2.0 ng/ml, P < 0.05; TIMP-2: 9.5 vs 4.0 ng/ml, P < 0.001). BM-MSC injection inhibited infiltration of M1 macrophages and preserved the construction of elastin. CONCLUSIONS: Our results suggest that BM-MSCs might be an effective treatment for AA. Further investigation is necessary to optimize the injected dosage and the frequency of BM-MSCs to prevent a transient effect.", "author" : [ { "dropping-particle" : "", "family" : "Yamawaki-Ogata", "given" : "A", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Fu", "given" : "X", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Hashizume", "given" : "R", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Fujimoto", "given" : "K L", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Araki", "given" : "Y", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Oshima", "given" : "H", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Narita", "given" : "Y", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Usui", "given" : "A", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Eur J Cardiothorac Surg", "id" : "ITEM-3", "issue" : "5", "issued" : { "date-parts" : [ [ "2014" ] ] }, "note" : "Yamawaki-Ogata, Aika\nFu, Xianming\nHashizume, Ryotaro\nFujimoto, Kazuro L\nAraki, Yoshimori\nOshima, Hideki\nNarita, Yuji\nUsui, Akihiko\neng\nResearch Support, Non-U.S. Gov't\nGermany\n2014/02/21 06:00\nEur J Cardiothorac Surg. 2014 May;45(5):e156-65. doi: 10.1093/ejcts/ezu018. Epub 2014 Feb 18.", "page" : "e156-65", "title" : "Therapeutic potential of bone marrow-derived mesenchymal stem cells in formed aortic aneurysms of a mouse model", "type" : "article-journal", "volume" : "45" }, "uris" : [ "http://www.mendeley.com/documents/?uuid=54914d4d-6109-4cbc-90b9-e61331b8459c" ] } ], "mendeley" : { "formattedCitation" : "192\u2013194", "plainTextFormattedCitation" : "192\u2013194", "previouslyFormattedCitation" : "192\u2013194" }, "properties" : { }, "schema" : "https://github.com/citation-style-language/schema/raw/master/csl-citation.json" }192194
[H3] Pharmacotherapy in clinical trials
P r o p r a n o l o l , a - b l o c k e r , w a s o n e o f t h e f i r s t d r u g s t o i n h i b i t t h e d e v e l o p m e n t o f A A A i n a n i m a l m o d e l s . H o w e v e r , i n a r a n d o m i z e d t r i a l , p a t i e n t s w i t h A A A d i d n o t t o l e r a t e p r o p r a n o l o l w e l l , a n d t h e d r u g d i d n o t s i g n i f i c a n t l y a f f e c t t h e g r o w t h r a t e o f A A A .
Chlamydia pneumoniae, but few other bacteria, have been detected at a significantly higher frequency in the wall of AAAs than in the wall of controls. Chlamydia pneumoniae is therefore suspected to have a pathogenic role in AAA development, although this has not been formally proven.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "ISSN" : "0741-5214", "PMID" : "9081131", "abstract" : "BACKGROUND Seroepidemiologic studies have indicated an association between chronic Chlamydia pneumoniae infection and coronary heart disease. The organism, which is a common respiratory pathogen, has been demonstrated in atherosclerotic lesions of the aorta and coronary arteries. Abdominal aortic aneurysms are frequently associated with atherosclerosis, and inflammation may actually be an important factor in aneurysmal dilatation. Hence it could be assumed that C. pneumoniae may play a role in maintaining an inflammation and triggering the development of aortic aneurysms. METHODS AND RESULTS Specimens from abdominal aortic aneurysm were examined for the presence of C. pneumoniae by immunohistochemical analysis, the polymerase chain reaction amplifying omp 1 gene, transmission electron microscopy, and culture methods with histologically atherosclerosis-negative human aortic tissues used as a control group. Chlamydial lipopolysaccharide and C. pneumoniae specific antigens were found by immunohistochemistry in 12 and 8 of 12 aneurysm specimens, respectively, and C. pneumoniae DNA could be demonstrated in 6 of 6 aneurysm specimens studied. Furthermore electron microscopy revealed the presence of Chlamydia-like elementary bodies in three of four aneurysm specimens tested. None of the control samples gave positive reaction in the polymerase chain reaction, and C. pneumoniae antigens were not detected in any of them. CONCLUSIONS C. pneumoniae is frequently found in the vessel wall of abdominal aortic aneurysm. The potential etiopathogenetic role of C. pneumoniae in the development of these aneurysms remains to be studied.", "author" : [ { "dropping-particle" : "", "family" : "Juvonen", "given" : "J", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Juvonen", "given" : "T", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Laurila", "given" : "A", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Alak\u00e4rpp\u00e4", "given" : "H", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Lounatmaa", "given" : "K", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Surcel", "given" : "H M", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Leinonen", "given" : "M", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Kairaluoma", "given" : "M I", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Saikku", "given" : "P", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Journal of vascular surgery", "id" : "ITEM-1", "issue" : "3", "issued" : { "date-parts" : [ [ "1997", "3" ] ] }, "page" : "499-505", "title" : "Demonstration of Chlamydia pneumoniae in the walls of abdominal aortic aneurysms.", "type" : "article-journal", "volume" : "25" }, "uris" : [ "http://www.mendeley.com/documents/?uuid=f6b6a70d-cee1-396f-aac0-c28321c7abe2" ] }, { "id" : "ITEM-2", "itemData" : { "DOI" : "S0741-5214(01)15832-5 [pii]\r10.1067/mva.2001.117891", "ISBN" : "0741-5214 (Print)\r0741-5214 (Linking)", "PMID" : "11668312", "abstract" : "OBJECTIVE: Eradication of Chlamydia pneumoniae infection and inhibition of elastolytic matrix metalloproteinases with doxycycline have been suggested to reduce the growth rates of small abdominal aortic aneurysms (AAA). We designed a study to investigate the efficacy of doxycycline in reducing the expansion of small AAAs. SUBJECTS AND METHODS: This was a prospective, double-blind, randomized, placebo-controlled study that was set in a university referral hospital. The study group consisted of 32 of 34 initially eligible patients who had an AAA diameter perpendicular to the aortic axis of 30 mm or more in size or a ratio of infrarenal to suprarenal aortic diameter of 1.2 or more and a diameter less than 55 mm. Patients were randomly assigned to receive either doxycycline (150 mg daily) or placebo during a 3-month period and underwent ultrasound surveillance during an 18-month period. Outcome measures included aneurysm expansion rates, the number of patients who had AAA rupture or repair, C pneumoniae antibody titers, and serum concentrations of C-reactive protein. RESULTS: The aneurysm expansion rate in the doxycycline group was significantly lower than that in the placebo group during the 6- to 12-month (P = .01) and the 12- to 18-month periods (P =.01). Five patients (41%) in the placebo group and 1 patient (7%) in the doxycycline group had an overall expansion of the aneurysm of 5 mm or more during the 18-month follow-up. Among the placebo group patients, a higher expansion rate was observed in those with enhanced C pneumoniae immunoglobulin G antibody titers (> 128) than in those with lower titers (P = .03). Doxycycline treatment had no clear effect on antibody titers. However, at 6-month follow-up, C-reactive protein levels in the doxycycline group were significantly lower than the baseline levels (P = .01). CONCLUSIONS: The results of this small pilot study suggest that doxycycline may favorably alter the outcome of patients with small AAA. However, because of the small size of this randomized study and of the potentially confounding effect of pretreatment risk factors, doxycycline-based treatment cannot be justified only on the ground of the current results. Because of the high prevalence of this disorder and its clinical, social, and economic relevance, a multicenter study should be performed to further investigate whether there is any place for medical treatment of small AAAs.", "author" : [ { "dropping-particle" : "", "family" : "Mosorin", "given" : "M", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Juvonen", "given" : "J", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Biancari", "given" : "F", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Satta", "given" : "J", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Surcel", "given" : "H M", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Leinonen", "given" : "M", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Saikku", "given" : "P", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Juvonen", "given" : "T", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "J Vasc Surg", "edition" : "2001/10/23", "id" : "ITEM-2", "issue" : "4", "issued" : { "date-parts" : [ [ "2001" ] ] }, "language" : "eng", "note" : "Mosorin, M\nJuvonen, J\nBiancari, F\nSatta, J\nSurcel, H M\nLeinonen, M\nSaikku, P\nJuvonen, T\nClinical Trial\nRandomized Controlled Trial\nUnited States\nJournal of vascular surgery\nJ Vasc Surg. 2001 Oct;34(4):606-10.", "page" : "606-610", "title" : "Use of doxycycline to decrease the growth rate of abdominal aortic aneurysms: a randomized, double-blind, placebo-controlled pilot study", "type" : "article-journal", "volume" : "34" }, "uris" : [ "http://www.mendeley.com/documents/?uuid=5c8756cd-0fcb-4a87-9666-ef048abd53a2" ] } ], "mendeley" : { "formattedCitation" : "195,196", "plainTextFormattedCitation" : "195,196", "previouslyFormattedCitation" : "195,196" }, "properties" : { }, "schema" : "https://github.com/citation-style-language/schema/raw/master/csl-citation.json" }195,196 Therefore, randomized clinical trials of antibiotics, including doxycycline and azithromycin, were conducted previously, but did not clearly demonstrate the effect of reducing AAA growth rate.
Later, doxycycline was expected to act as a MMP inhibitor, and was administered in a larger number of patients for longer periods at a comparable dose, but still doxycycline treatment did not reduce AAA growth.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.7326/0003-4819-159-12-201312170-00007", "ISBN" : "1539-3704 (Electronic)\r0003-4819 (Linking)", "PMID" : "24490266", "abstract" : "BACKGROUND: Doxycycline inhibits formation and progression of abdominal aortic aneurysms (AAAs) in preclinical models of the disease, but it is unclear whether and how this observation translates to humans. OBJECTIVE: To test whether doxycycline inhibits AAA progression in humans. DESIGN: Randomized, placebo-controlled, double-blind trial. (Dutch Trial Registry: NTR 1345) SETTING: 14 Dutch hospitals. PATIENTS: 286 patients with small AAAs between October 2008 and June 2011. INTERVENTION: Daily dose of 100 mg of doxycycline (n = 144) or placebo (n = 142) for 18 months. MEASUREMENTS: The primary outcome measure was aneurysm growth at 18 months, as estimated by repeated single-observer ultrasonography. Secondary outcomes included growth at 6 and 12 months and the need for elective surgery. RESULTS: Mean aneurysm diameter (approximately 43 mm) and other baseline characteristics were similar in both groups. Doxycycline treatment was associated with increased aneurysm growth (4.1 mm in the doxycycline group vs. 3.3 mm in the placebo group at 18 months; difference, 0.8 mm [95% CI, 0.1 to 1.4 mm]; P = 0.016 mm). Twenty-one patients receiving doxycycline and 22 patients receiving placebo had elective surgical repair (Kaplan-Meier estimates were 16.1% for those receiving doxycycline and 16.5% for those receiving placebo; difference, -0.4% [CI, -9.3% to 8.5%]; P = 0.83). Time to repair was similar in the groups (P = 0.92). LIMITATIONS: This study focuses on patients with small AAAs. As such, whether the data can be extrapolated to larger AAAs (>55 mm) is unclear. The high number of elective repairs (n = 43) was unanticipated. Moreover, the study did not follow patients who withdrew because of an adverse effect. CONCLUSION: This trial found that 18 months of doxycycline therapy did not reduce aneurysm growth and did not influence the need for AAA repair or time to repair. PRIMARY FUNDING SOURCE: The Netherlands Organisation for Health Research and Development, and the NutsOhra Fund.", "author" : [ { "dropping-particle" : "", "family" : "Meijer", "given" : "C A", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Stijnen", "given" : "T", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Wasser", "given" : "M N", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Hamming", "given" : "J F", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Bockel", "given" : "J H", "non-dropping-particle" : "van", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Lindeman", "given" : "J H", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Pharmaceutical Aneurysm Stabilisation Trial Study", "given" : "Group", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Ann Intern Med", "id" : "ITEM-1", "issue" : "12", "issued" : { "date-parts" : [ [ "2013" ] ] }, "note" : "Meijer, C Arnoud\nStijnen, Theo\nWasser, Martin N J M\nHamming, Jaap F\nvan Bockel, J Hajo\nLindeman, Jan H N\neng\nMulticenter Study\nRandomized Controlled Trial\nResearch Support, Non-U.S. Gov't\n2014/02/04 06:00\nAnn Intern Med. 2013 Dec 17;159(12):815-23. doi: 10.7326/0003-4819-159-12-201312170-00007.", "page" : "815-823", "title" : "Doxycycline for stabilization of abdominal aortic aneurysms: a randomized trial", "type" : "article-journal", "volume" : "159" }, "uris" : [ "http://www.mendeley.com/documents/?uuid=520ab43e-cf39-4b18-9ebd-a60e034d5504" ] } ], "mendeley" : { "formattedCitation" : "44", "plainTextFormattedCitation" : "44", "previouslyFormattedCitation" : "44" }, "properties" : { }, "schema" : "https://github.com/citation-style-language/schema/raw/master/csl-citation.json" }44 Recently, two randomized trials with pemirolast, a mast cell inhibitor, and perindopril, an ACE inhibitor, have been reported, but neither drug reduced AAA growth rate.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1002/bjs.9824", "ISBN" : "1365-2168 (Electronic)\r0007-1323 (Linking)", "PMID" : "25963302", "abstract" : "BACKGROUND: Abdominal aortic aneurysm (AAA) is thought to develop as a result of inflammatory processes in the aortic wall. In particular, mast cells are believed to play a central role. The AORTA trial was undertaken to investigate whether the mast cell inhibitor, pemirolast, could retard the growth of medium-sized AAAs. In preclinical and clinical trials, pemirolast has been shown to inhibit antigen-induced allergic reactions. METHODS: Inclusion criteria for the trial were patients with an AAA of 39-49 mm in diameter on ultrasound imaging. Among exclusion criteria were previous aortic surgery, diabetes mellitus, and severe concomitant disease with a life expectancy of less than 2 years. Included patients were treated with 10, 25 or 40 mg pemirolast, or matching placebo for 52 weeks. The primary endpoint was change in aortic diameter as measured from leading edge adventitia at the anterior wall to leading edge adventitia at the posterior wall in systole. All ultrasound scans were read in a central imaging laboratory. RESULTS: Some 326 patients (mean age 70.8 years; 88.0 per cent men) were included in the trial. The overall mean growth rate was 2.42 mm during the 12-month study. There was no statistically significant difference in growth between patients receiving placebo and those in the three dose groups of pemirolast. Similarly, there were no differences in adverse events. CONCLUSION: Treatment with pemirolast did not retard the growth of medium-sized AAAs. REGISTRATION NUMBER: NCT01354184 (https://www.clinicaltrials.gov).", "author" : [ { "dropping-particle" : "", "family" : "Sillesen", "given" : "H", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Eldrup", "given" : "N", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Hultgren", "given" : "R", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Lindeman", "given" : "J", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Bredahl", "given" : "K", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Thompson", "given" : "M", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Wanhainen", "given" : "A", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Wingren", "given" : "U", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Swedenborg", "given" : "J", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Investigators", "given" : "Aorta Trial", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Br J Surg", "id" : "ITEM-1", "issue" : "8", "issued" : { "date-parts" : [ [ "2015" ] ] }, "note" : "Sillesen, H\nEldrup, N\nHultgren, R\nLindeman, J\nBredahl, K\nThompson, M\nWanhainen, A\nWingren, U\nSwedenborg, J\neng\nMulticenter Study\nRandomized Controlled Trial\nResearch Support, Non-U.S. Gov't\nEngland\n2015/05/13 06:00\nBr J Surg. 2015 Jul;102(8):894-901. doi: 10.1002/bjs.9824. Epub 2015 May 12.", "page" : "894-901", "title" : "Randomized clinical trial of mast cell inhibition in patients with a medium-sized abdominal aortic aneurysm", "type" : "article-journal", "volume" : "102" }, "uris" : [ "http://www.mendeley.com/documents/?uuid=91cfe1d6-3027-4ef1-acb3-ca381740c3a1" ] } ], "mendeley" : { "formattedCitation" : "45", "plainTextFormattedCitation" : "45", "previouslyFormattedCitation" : "45" }, "properties" : { }, "schema" : "https://github.com/citation-style-language/schema/raw/master/csl-citation.json" }45 Several small observational studies demonstrated an association between statin administration and decreased AAA growth, although the beneficial effect of statins has not been confirmed in larger clinical trials.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1016/j.jvs.2016.08.003", "ISBN" : "1097-6809 (Electronic)\r0741-5214 (Linking)", "PMID" : "27641464", "abstract" : "OBJECTIVE: This review describes ongoing efforts to develop a medical therapy to limit abdominal aortic aneurysm (AAA) growth. METHODS: Data from animal model studies, human investigations, and clinical trials are described. RESULTS: Studies in rodent models and human samples have suggested a number of potential targets for slowing or halting AAA growth. A number of clinical trials are now examining the value of medications targeting some of the pathways identified. These trials have a number of challenges, including identifying medications safe to use in older patients with multiple comorbidities, developing accurate outcome assessments, and minimizing the dropout of patients during the trials. Three recent trials have reported no benefit of the antibiotic doxycycline, a mast cell inhibitor, an angiotensin-converting enzyme inhibitor, or a calcium channel blocker in limiting AAA growth. A number of other trials examining angiotensin receptor blockers, cyclosporine, and an antiplatelet agent are currently underway. CONCLUSIONS: Further refinement of drug discovery pathways and testing paradigms are likely needed to develop effective nonsurgical therapies for AAA.", "author" : [ { "dropping-particle" : "", "family" : "Golledge", "given" : "J", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Norman", "given" : "P E", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Murphy", "given" : "M P", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Dalman", "given" : "R L", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "J Vasc Surg", "id" : "ITEM-1", "issue" : "1", "issued" : { "date-parts" : [ [ "2017" ] ] }, "note" : "Golledge, Jonathan\nNorman, Paul E\nMurphy, Michael P\nDalman, Ronald L\neng\nReview\n2016/09/20 06:00\nJ Vasc Surg. 2017 Jan;65(1):225-233. doi: 10.1016/j.jvs.2016.08.003. Epub 2016 Sep 15.", "page" : "225-233", "title" : "Challenges and opportunities in limiting abdominal aortic aneurysm growth", "type" : "article-journal", "volume" : "65" }, "uris" : [ "http://www.mendeley.com/documents/?uuid=5d262c36-f7d0-4794-bd46-46114ae34121" ] }, { "id" : "ITEM-2", "itemData" : { "DOI" : "10.2174/1389450119666171227223331", "ISBN" : "1873-5592 (Electronic)\r1389-4501 (Linking)", "PMID" : "29284386", "abstract" : "Abdominal aortic aneurysm (AAA), a common disease involving the segmental expansion and rupture of the aorta, has a high mortality rate. Therapeutic options for AAA are currently limited to surgical repair to prevent catastrophic rupture. Non-surgical approaches, particularly pharmacotherapy, are lacking for the treatment of AAA. Here, we review both basic and clinical studies and discuss the current challenges to developing medical therapy that reduces AAA progression. Studies using animal models of AAA progression and human AAA explant cultures have identified several potential targets for preventing AAA growth. However, no clinical studies have convincingly confirmed the efficacy of any pharmacologic treatment against the growth of AAA. Thus, there is as yet no strong recommendation regarding pharmacotherapy to reduce the risk of AAA progression and rupture. This review identifies concerns that need to be addressed for the field to progress and discusses the challenges that must be overcome in order to develop effective pharmacotherapy to reduce AAA progression in the future.", "author" : [ { "dropping-particle" : "", "family" : "Yoshimura", "given" : "K", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Morikage", "given" : "N", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Nishino-Fujimoto", "given" : "S", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Furutani", "given" : "A", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Shirasawa", "given" : "B", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Hamano", "given" : "K", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Curr Drug Targets", "id" : "ITEM-2", "issued" : { "date-parts" : [ [ "2017" ] ] }, "note" : "Yoshimura, Koichi\nMorikage, Noriyasu\nNishino-Fujimoto, Shizuka\nFurutani, Akira\nShirasawa, Bungo\nHamano, Kimikazu\neng\nNetherlands\n2017/12/30 06:00\nCurr Drug Targets. 2017 Dec 27. pii: CDT-EPUB-87605. doi: 10.2174/1389450119666171227223331.", "title" : "Current Status and Perspectives on Pharmacologic Therapy for Abdominal Aortic Aneurysm", "type" : "article-journal" }, "uris" : [ "http://www.mendeley.com/documents/?uuid=63fb58d8-47ab-429e-a414-39b0fe1fc2b3" ] }, { "id" : "ITEM-3", "itemData" : { "DOI" : "10.1016/j.ejvs.2015.08.010", "ISBN" : "1532-2165 (Electronic)\r1078-5884 (Linking)", "PMID" : "26482507", "abstract" : "BACKGROUND: Management of abdominal aortic aneurysms (AAAs) relies on surgical repair of larger AAAs. Consequently medical interventions inhibiting AAA progression could greatly reduce the need for surgical repair. A spectrum of pharmaceutical strategies has been reported, albeit conclusions often appear contradictory. Given the longstanding interest in pharmaceutical AAA stabilization, a systematic review of the available literature is relevant. OBJECTIVES: The aim is to provide an up to date systematic review of the available data on pharmaceutical therapies for stabilizing or impeding AAA growth. METHODS: A search using Pubmed, Embase, Web of science, Cochrane, CINAHL, Academic Search Premier, and Science Direct identified 27 eligible papers that studied the clinical effect of the pharmaceutical therapy on AAA diameter growth. RESULTS: This review shows that there is currently no pharmaceutical strategy that reduces AAA growth. Most studies are of poor methodological quality. Initial promising reports are often not confirmed in subsequent larger studies, raising the possibility of selective reporting. CONCLUSION: There is currently no pharmaceutical means that halts AAA growth.", "author" : [ { "dropping-particle" : "", "family" : "Kokje", "given" : "V B", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Hamming", "given" : "J F", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Lindeman", "given" : "J H", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Eur J Vasc Endovasc Surg", "id" : "ITEM-3", "issue" : "6", "issued" : { "date-parts" : [ [ "2015" ] ] }, "note" : "Kokje, V B C\nHamming, J F\nLindeman, J H N\neng\nReview\nEngland\n2015/10/21 06:00\nEur J Vasc Endovasc Surg. 2015 Dec;50(6):702-13. doi: 10.1016/j.ejvs.2015.08.010. Epub 2015 Oct 9.", "page" : "702-713", "title" : "Editor's Choice - Pharmaceutical Management of Small Abdominal Aortic Aneurysms: A Systematic Review of the Clinical Evidence", "type" : "article-journal", "volume" : "50" }, "uris" : [ "http://www.mendeley.com/documents/?uuid=4efa3b49-03a6-4dcd-a188-8026d4d1eb35" ] } ], "mendeley" : { "formattedCitation" : "187,188,197", "plainTextFormattedCitation" : "187,188,197", "previouslyFormattedCitation" : "187,188,197" }, "properties" : { }, "schema" : "https://github.com/citation-style-language/schema/raw/master/csl-citation.json" }187,188,197 There is no scientific evidence currently that support pharmacological treatment to reduce AAA growth in humans.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1016/j.jvs.2009.07.002", "ISBN" : "1097-6809 (Electronic)\r0741-5214 (Linking)", "PMID" : "19786250", "author" : [ { "dropping-particle" : "", "family" : "Chaikof", "given" : "E L", "non-dropping-particle" : 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06:00\nEur Heart J. 2014 Nov 1;35(41):2873-926. doi: 10.1093/eurheartj/ehu281. Epub 2014 Aug 29.", "page" : "2873-2926", "title" : "2014 ESC Guidelines on the diagnosis and treatment of aortic diseases: Document covering acute and chronic aortic diseases of the thoracic and abdominal aorta of the adult. The Task Force for the Diagnosis and Treatment of Aortic Diseases of the European ", "type" : "article-journal", "volume" : "35" }, "uris" : [ "http://www.mendeley.com/documents/?uuid=09b9aeac-f12e-4c12-b886-252225b35e70" ] } ], "mendeley" : { "formattedCitation" : "198,199", "plainTextFormattedCitation" : "198,199", "previouslyFormattedCitation" : "198,199" }, "properties" : { }, "schema" : "https://github.com/citation-style-language/schema/raw/master/csl-citation.json" }198,199
[H1] Quality of life
Both diagnosis and treatment of AAA have an impact on patients quality of life (QOL). Men diagnosed with an AAA show a temporary reduction in mental QOL during the first year, but then they tend to think progressively less about it. In contrast, the impact on physical QOL seems to be more permanent, and men with a diagnosed AAA have a consistently lower physical QOL than men without an AAA. (ref Br J Surg. 2018 Feb;105(3):203-208. doi: 10.1002/bjs.10721. Impact of abdominal aortic aneurysm screening on quality of life. Bath MF1, Sidloff D1, Saratzis A1, Bown MJ1; UK Aneurysm Growth Study investigators.) Vascular surgeons and patients judge the success of AAA repair differently. Traditional endpoints surgeons use to evaluate outcomes after a surgical procedure include mortality and morbidity. Patients evaluate the success of their operation based also on quality of life (QOL) and capability to be discharged from hospital to home. Indeed, there is increasing recognition that QOL and patient satisfaction should be considered when evaluating outcomes of a specific treatment.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1093/bja/aex360", "ISBN" : "1471-6771 (Electronic)\r0007-0912 (Linking)", "PMID" : "29161397", "abstract" : "The past two decades have seen an increasing recognition that the delivery of safe surgery with low complication rates and good long-term outcomes is a team endeavour embracing the whole patient care pathway. The key role of the anaesthetist in managing the patient through the surgical process is widely understood and has driven the emergence of perioperative medicine. In parallel with these developments there has been a sea change in the organisation of the care of patients presenting for elective abdominal aortic aneurysm (AAA) repair. Data from the 2008 report of the VASCUNET vascular registry suggested that the UK had the highest mortality for elective open AAA repair in Europe (7.9%). In response, a national quality improvement programme (AAAQIP) spanning the disciplines of surgery, anaesthesia, radiology and nursing was put in place. This led to significant changes in all aspects of AAA repair including the role of the anaesthetist. Preoperative assessment by an anaesthetist with a vascular practice was mandated and the role of the anaesthetist in the vascular multidisciplinary team meeting (MDT) established. Anaesthetic data were included in the national data collection system for vascular surgery, the National Vascular Registry. These changes paralleled and in some cases led the wider evolution of the role of the anaesthetist in perioperative medicine. The mortality from infrarenal AAA repair in the UK decreased to 2.4% by 2012. This improvement reflects changes in perioperative care supported and in some cases led by anaesthetists.", "author" : [ { "dropping-particle" : "", "family" : "Howell", "given" : "S J", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Br J Anaesth", "id" : "ITEM-1", "issue" : "suppl_1", "issued" : { "date-parts" : [ [ "2017" ] ] }, "note" : "Howell, S J\neng\nEngland\n2017/11/22 06:00\nBr J Anaesth. 2017 Dec 1;119(suppl_1):i15-i22. doi: 10.1093/bja/aex360.", "page" : "i15-i22", "title" : "Abdominal aortic aneurysm repair in the United Kingdom: an exemplar for the role of anaesthetists in perioperative medicine", "type" : "article-journal", "volume" : "119" }, "uris" : [ "http://www.mendeley.com/documents/?uuid=a1dd5592-1598-4460-be31-6f0847dcd6a6" ] } ], "mendeley" : { "formattedCitation" : "220", "plainTextFormattedCitation" : "220", "previouslyFormattedCitation" : "220" }, "properties" : { }, "schema" : "https://github.com/citation-style-language/schema/raw/master/csl-citation.json" }220 Particularly for AAA repair, the significant reduction of perioperative mortality and morbidity after AAA repair, increases the relevance of evaluating QOL.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1097/01.RVI.0000167858.16223.D5", "ISBN" : "1051-0443 (Print)\r1051-0443 (Linking)", "PMID" : "16105921", "abstract" : "PURPOSE: To compare functional autonomy, quality of life (QOL), and pain control after endovascular and open repair (OR) of abdominal aortic aneurysms. MATERIALS AND METHODS: Forty patients with a low surgical risk profile and anatomic compatibility for stent-graft therapy were randomized to receive OR or endovascular aneurysm repair (EVAR). Technical and clinical success as well as mortality were assessed in both groups and compared by Kaplan-Meier analysis. Functional autonomy and QOL were assessed by Karnofsky score and Short Form 36 (SF-36) questionnaire. Pain control was assessed by a numeric rating scale and Brief Pain Inventory questionnaire. QOL outcomes by means of the SF-36 and pain questionnaires were compared with use of mixed-effects models for repeated-measures analysis. RESULTS: All procedures were technically successful in both groups. Three late clinical failures requiring surgical conversion or repeated intervention were observed in the EVAR group and one was observed in the OR group. There was no significant difference between groups in terms of functional autonomy or QOL. No difference in pain level was evident during the early postoperative period, whereas the pain level was lower in the OR group after 1 month. Opioid analgesic drug consumption was significantly greater in the OR group during the postoperative period. Mean hospitalization duration was shorter in the EVAR group than in the OR group (4.5 days +/- 2.4 vs 11.5 days +/- 8.1; P= .001). CONCLUSION: EVAR has no advantage over OR in patients at low risk in terms of functional autonomy, QOL, and pain control. However, EVAR was associated with shorter hospitalization durations compared with OR.", "author" : [ { "dropping-particle" : "", "family" : "Soulez", "given" : "G", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Therasse", "given" : "E", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Monfared", "given" : "A A", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Blair", "given" : "J F", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Choiniere", "given" : "M", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Elkouri", "given" : "S", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Beaudoin", "given" : "N", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Giroux", "given" : "M F", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Cliche", "given" : "A", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Lelorier", "given" : "J", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Oliva", "given" : "V L", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "J Vasc Interv Radiol", "id" : "ITEM-1", "issue" : "8", "issued" : { "date-parts" : [ [ "2005" ] ] }, "note" : "Soulez, Gilles\nTherasse, Eric\nMonfared, Amir Abbas Tahami\nBlair, Jean-Francois\nChoiniere, Manon\nElkouri, Stephane\nBeaudoin, Nathalie\nGiroux, Marie-France\nCliche, Andree\nLelorier, Jacques\nOliva, Vincent L\neng\n15189-1/Canadian Institutes of Health Research/Canada\nComparative Study\nRandomized Controlled Trial\nResearch Support, Non-U.S. Gov't\n2005/08/18 09:00\nJ Vasc Interv Radiol. 2005 Aug;16(8):1093-100. doi: 10.1097/01.RVI.0000167858.16223.D5.", "page" : "1093-1100", "title" : "Pain and quality of life assessment after endovascular versus open repair of abdominal aortic aneurysms in patients at low risk", "type" : "article-journal", "volume" : "16" }, "uris" : [ "http://www.mendeley.com/documents/?uuid=d6c279d6-7f8a-43c9-94fc-eafec9a8a331" ] }, { "id" : "ITEM-2", "itemData" : { "DOI" : "10.1016/j.ejvs.2009.08.008", "ISBN" : "1532-2165 (Electronic)\r1078-5884 (Linking)", "PMID" : "19775919", "abstract" : "OBJECTIVES: To determine whether men with small abdominal aortic aneurysm have a preference between either endovascular or open aneurysm repair for future treatment. DESIGN: Prospective study of self-declared treatment preference following receipt of a validated patient information pack. PARTICIPANTS: Men aged 65-84 years (n=237) with asymptomatic aneurysm (4.0-5.4 cm) detected by population-based screening. METHODS: An unbiased, validated patient information pack and questionnaire were developed to conduct a postal survey. RESULTS: One hundred sixty seven participants (70%) returned a completed questionnaire; 24 (10%) did not respond at all. Initially, only 38 (23%) declared a treatment preference. After reading the information pack, 130 participants (80%) declared a treatment preference: 30 preferred open repair (18%), 77 endovascular repair (46%), 23 were happy with either option (14%) and only 34 remained without any preference (20%). Nearly all (92%) thought that the information pack had prepared them well for future discussions with clinicians and with no single feature identified as influencing the preference-making process, 66 respondents (40%) still opted to 'take the advice of the doctor'. CONCLUSION: The patient information pack facilitated the development of treatment preferences with endovascular repair being preferred to open repair. Nevertheless for patient-centred care, vascular centres must continue to safely provide both open and endovascular repair.", "author" : [ { "dropping-particle" : "", "family" : "Reise", "given" : "J A", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Sheldon", "given" : "H", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Earnshaw", "given" : "J", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Naylor", "given" : "A R", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Dick", "given" : "F", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Powell", "given" : "J T", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Greenhalgh", "given" : "R M", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Eur J Vasc Endovasc Surg", "id" : "ITEM-2", "issue" : "1", "issued" : { "date-parts" : [ [ "2010" ] ] }, "note" : "Reise, J A\nSheldon, H\nEarnshaw, J\nNaylor, A R\nDick, F\nPowell, J T\nGreenhalgh, R M\neng\nResearch Support, Non-U.S. Gov't\nEngland\n2009/09/25 06:00\nEur J Vasc Endovasc Surg. 2010 Jan;39(1):55-61. doi: 10.1016/j.ejvs.2009.08.008. Epub 2009 Sep 22.", "page" : "55-61", "title" : "Patient preference for surgical method of abdominal aortic aneurysm repair: postal survey", "type" : "article-journal", "volume" : "39" }, "uris" : [ "http://www.mendeley.com/documents/?uuid=c501c149-9123-4104-b011-bd09d1ef464b" ] }, { "id" : "ITEM-3", "itemData" : { "DOI" : "10.1016/j.ejvs.2008.07.003", "ISBN" : "1532-2165 (Electronic)\r1078-5884 (Linking)", "PMID" : "18710698", "author" : [ { "dropping-particle" : "", "family" : "Kolh", "given" : "P", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Eur J Vasc Endovasc Surg", "id" : "ITEM-3", "issue" : "3", "issued" : { "date-parts" : [ [ "2008" ] ] }, "note" : "Kolh, P\neng\nComment\nEditorial\nEngland\n2008/08/20 09:00\nEur J Vasc Endovasc Surg. 2008 Sep;36(3):290-1. doi: 10.1016/j.ejvs.2008.07.003.", "page" : "290-291", "title" : "Quality of life after abdominal aortic aneurysm repair: similar long-term results with endovascular and open techniques", "type" : "article-journal", "volume" : "36" }, "uris" : [ "http://www.mendeley.com/documents/?uuid=b79dd9bb-a042-4b47-a3b1-e39e80eb75ea" ] }, { "id" : "ITEM-4", "itemData" : { "DOI" : "10.1016/j.jvs.2006.08.015", "ISBN" : "0741-5214 (Print)\r0741-5214 (Linking)", "PMID" : "17145419", "abstract" : "PURPOSE: This study evaluated and compared changes over time in health-related quality of life reported by patients with infrarenal abdominal aortic aneurysm (AAA) undergoing elective endovascular (EVAR) and open aneurysm (OR) repair. METHODS: A prospective, nonrandomized cohort of 76 patients (62 men, 14 women; age range, 42 to 89 years) undergoing elective, infrarenal AAA repair (EVAR, n = 43; OR, n = 33) at two university teaching hospitals during a 15-month period were administered the Medical Outcomes Study Short-Form 36-item (SF-36) health survey preoperatively and then 1 week, 1 month, and 6 months postoperatively. Patient demographics, procedural details, postoperative follow-up data, and SF-36 scores were compared between groups. RESULTS: Both groups had total SF-36 scores that were significantly lower than preoperative scores at 1 week and 1 month after surgery but were not significantly different from the preoperative scores at 6 months (OR 66.2 +/- 21.1 to 72.3 +/- 19.8, P > .1; and EVAR 61.0 +/- 17.7 to 58.7 +/- 19.4, P > .1). Six-month total SF-36 scores were significantly higher in the OR group compared with the EVAR group (mean 72.3 +/- 19.8 OR vs 58.7 +/- 19.4 EVAR; P = .009). In the postoperative period, a significant drop occurred in mean scores in six of the eight domains of the SF-36 in the OR patients (physical function, PF; role physical, RP; bodily pain, BP; vitality, VT; social function, SF; role emotional, RE) and five domains for EVAR patients (PF, RP, BP, SF, RE). In two domains, RE and PF, scores returned to baseline values significantly sooner in EVAR patients than in OR patients (RE, EVAR 1 month vs OR 6 months; and PF, EVAR 1 month vs OR 6 months). In the VT domain, no significant postoperative drop occurred in the EVAR group, but in the OR group, mean scores were significantly lower at 1 week and 1 month compared with preoperative values. In the domains of general health and mental health, no significant drop occurred in SF-36 score postoperatively in either group. CONCLUSIONS: Patient reported health-related quality of life after infrarenal AAA repair is significantly impaired in the early postoperative period but returns to baseline by 6 months in patients treated with EVAR and OR. Patients having EVAR had significantly more rapid return to preoperative scores in selected domains of the SF-36. Even though EVAR is associated with shorter and less invasive perioperative hospital course and fewer postoperative complicatio\u2026", "author" : [ { "dropping-particle" : "", "family" : "Aljabri", "given" : "B", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Wahaibi", "given" : "K", "non-dropping-particle" : "Al", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Abner", "given" : "D", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Mackenzie", "given" : "K S", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Corriveau", "given" : "M M", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Obrand", "given" : "D I", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Meshefedjian", "given" : "G", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Steinmetz", "given" : "O K", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "J Vasc Surg", "id" : "ITEM-4", "issue" : "6", "issued" : { "date-parts" : [ [ "2006" ] ] }, "note" : "Aljabri, Badr\nAl Wahaibi, Khalifa\nAbner, Deborah\nMackenzie, Kent S\nCorriveau, Marc-Michel\nObrand, Daniel I\nMeshefedjian, Garbis\nSteinmetz, Oren K\neng\nComparative Study\nMulticenter Study\n2006/12/06 09:00\nJ Vasc Surg. 2006 Dec;44(6):1182-1187. doi: 10.1016/j.jvs.2006.08.015.", "page" : "1182-1187", "title" : "Patient-reported quality of life after abdominal aortic aneurysm surgery: a prospective comparison of endovascular and open repair", "type" : "article-journal", "volume" : "44" }, "uris" : [ "http://www.mendeley.com/documents/?uuid=193d35e6-174c-4b88-b16a-5ffa7eb44833" ] } ], "mendeley" : { "formattedCitation" : "221\u2013224", "plainTextFormattedCitation" : "221\u2013224", "previouslyFormattedCitation" : "221\u2013224" }, "properties" : { }, "schema" : "https://github.com/citation-style-language/schema/raw/master/csl-citation.json" }221224 Vascular surgeons should, therefore, aim to include evaluations of QOL and aim at improving patient satisfaction rather than merely measure adverse events (mortality & morbidity) as endpoints.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1016/j.jvs.2012.02.062", "ISBN" : "1097-6809 (Electronic)\r0741-5214 (Linking)", "PMID" : "22840902", "abstract" : "INTRODUCTION: Morbidity and mortality have traditionally been used as key markers of surgical outcome. However, as complication rates associated with abdominal aortic aneurysm (AAA) repair decrease, subjective measures, such as quality of life (QOL), are increasingly recognized as important indicators of treatment efficacy and quality of care. This review presents the existing evidence relating to QOL changes in patients undergoing AAA repair by open repair (OR) and endovascular techniques (EVAR) and challenges current misconceptions about the relative effect of these two procedures. METHODS: A comprehensive literature search was performed to identify studies relating to QOL or health status in AAA repair. Quality of included studies was assessed according to Scottish Intercollegiate Guidelines Network methodology. RESULTS: Twenty-three studies satisfied the inclusion criteria. Preoperative QOL in AAA patients has been previously suggested as being worse than that of the general population, that OR patients have a worse QOL in the early postoperative period, and that EVAR patients have a worse QOL in the longer term. None of these assertions is uniformly supported in the literature. From the existing evidence, no clear conclusions can be drawn about the relative QOL benefits of OR vs EVAR. CONCLUSIONS: There are a paucity of good-quality data relating to health status and QOL in patients undergoing AAA repair. Little is known about the prevalence of preoperative or postoperative symptoms and the degree to which these influence patient well-being. Further investigation is needed to clarify health status and QOL changes in these patients and allow clinicians to make targeted improvements in practice.", "author" : [ { "dropping-particle" : "", "family" : "Peach", "given" : "G", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Holt", "given" : "P", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Loftus", "given" : "I", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Thompson", "given" : "M M", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Hinchliffe", "given" : "R", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "J Vasc Surg", "id" : "ITEM-1", "issue" : "2", "issued" : { "date-parts" : [ [ "2012" ] ] }, "note" : "Peach, George\nHolt, Peter\nLoftus, Ian\nThompson, Matt M\nHinchliffe, Robert\neng\nNIHR-CS-011-008/Department of Health/United Kingdom\nMeta-Analysis\nReview\n2012/07/31 06:00\nJ Vasc Surg. 2012 Aug;56(2):520-7. doi: 10.1016/j.jvs.2012.02.062.", "page" : "520-527", "title" : "Questions remain about quality of life after abdominal aortic aneurysm repair", "type" : "article-journal", "volume" : "56" }, "uris" : [ "http://www.mendeley.com/documents/?uuid=ed87dfca-a483-4269-a909-ca8bb8e4e1c4" ] } ], "mendeley" : { "formattedCitation" : "225", "plainTextFormattedCitation" : "225", "previouslyFormattedCitation" : "225" }, "properties" : { }, "schema" : "https://github.com/citation-style-language/schema/raw/master/csl-citation.json" }225
Meta-analysis data have shown that AAA repair (either by open repair or EVAR) results in a significant deterioration of QOL (both physical and mental that is more evident in the first 3-6 months after treatment.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1002/bjs.9018", "ISBN" : "1365-2168 (Electronic)\r0007-1323 (Linking)", "PMID" : "23254440", "abstract" : "BACKGROUND: Repair of an abdominal aortic aneurysm (AAA) is undertaken to prevent rupture. Intervention is by either open repair (OR) or a more minimally invasive endovascular repair (EVAR). Quality-of-life (QoL) analysis is an important health outcome and a number of single studies have assessed QoL following OR and EVAR. This was a meta-analysis of published studies to assess the effect of an intervention on QoL in patients with an AAA. METHODS: A systematic literature search was undertaken for studies prospectively reporting QoL analysis in patients with an AAA undergoing elective intervention. A multivariable meta-analysis model was developed in which the outcomes were mean changes in QoL scores over time, both for all AAA repairs (OR and EVAR) and comparing OR with EVAR. RESULTS: Data were collated from 16 studies (14 OR, 12 EVAR). The results suggested that treating an AAA had an effect on patient-reported QoL, evident from the statistically significant changes predominantly in domains assessing physical ability and pain. QoL was affected most within the first 3 months after any form of intervention, and was more pronounced following OR. Furthermore, a deterioration in the Physical Component Summary score following an AAA repair (either OR or EVAR) was evident at 12 months after intervention. CONCLUSION: Treating an AAA deleteriously affects patient-reported QoL over the first year following intervention.", "author" : [ { "dropping-particle" : "", "family" : "Coughlin", "given" : "P A", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Jackson", "given" : "D", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "White", "given" : "A D", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Bailey", "given" : "M A", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Farrow", "given" : "C", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Scott", "given" : "D J", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Howell", "given" : "S J", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Br J Surg", "id" : "ITEM-1", "issue" : "4", "issued" : { "date-parts" : [ [ "2013" ] ] }, "note" : "Coughlin, P A\nJackson, D\nWhite, A D\nBailey, M A\nFarrow, C\nScott, D J A\nHowell, S J\neng\nMC_U105260558/Medical Research Council/United Kingdom\nMeta-Analysis\nReview\nEngland\n2012/12/21 06:00\nBr J Surg. 2013 Mar;100(4):448-55. doi: 10.1002/bjs.9018. Epub 2012 Dec 19.", "page" : "448-455", "title" : "Meta-analysis of prospective trials determining the short- and mid-term effect of elective open and endovascular repair of abdominal aortic aneurysms on quality of life", "type" : "article-journal", "volume" : "100" }, "uris" : [ "http://www.mendeley.com/documents/?uuid=92c7680b-3a4d-408a-9167-8393021f04f4" ] } ], "mendeley" : { "formattedCitation" : "226", "plainTextFormattedCitation" : "226", "previouslyFormattedCitation" : "226" }, "properties" : { }, "schema" : "https://github.com/citation-style-language/schema/raw/master/csl-citation.json" }226 Kayssi et al. compared QOL outcomes between EVAR and open AAA repair, by performing a meta-analysis of 5 randomized trials.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1016/j.jvs.2015.05.032", "ISBN" : "1097-6809 (Electronic)\r0741-5214 (Linking)", "PMID" : "26211382", "abstract" : "OBJECTIVE: Endovascular repair (EVAR) of abdominal aortic aneurysms is a safe alternative to open aneurysm repair (OAR) in selected patients. The aim of this study was to compare the health-related quality-of-life (HR-QoL) outcomes of patients following EVAR and OAR. METHODS: A literature search of PubMed, EMBASE, and the Cochrane Library identified five randomized trials that reported on HR-QoL in EVAR and OAR for elective management of infrarenal abdominal aortic aneurysms. No consistent HR-QOL instrument was used among the studies. A meta-analysis was performed on the 36-Item Short Form (SF-36) and the EuroQol-5D (EQ-5D) HR-QoL results. RESULTS: SF-36 general health scores were higher for EVAR at 3, 6, and 12 months postoperatively. SF-36 physical functioning scores were higher for EVAR at 6 months but this advantage was lost at 12 months. In addition, SF-36 social functioning scores were higher for EVAR at 12 months. SF-36 component summary scores were not significantly different. EVAR was associated with a better EQ-5D score at 3, 6, and 12 months, but not at 24 months of follow-up. CONCLUSIONS: EVAR was associated with better HR-QoL in some domains up to 12 months postoperatively. There is insufficient data to demonstrate a HR-QoL advantage beyond 12 months. More studies are required to examine any long-term HR-QoL advantages for either intervention.", "author" : [ { "dropping-particle" : "", "family" : "Kayssi", "given" : "A", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "DeBord Smith", "given" : "A", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Roche-Nagle", "given" : "G", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Nguyen", "given" : "L L", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "J Vasc Surg", "id" : "ITEM-1", "issue" : "2", "issued" : { "date-parts" : [ [ "2015" ] ] }, "note" : "Kayssi, Ahmed\nDeBord Smith, Ann\nRoche-Nagle, Graham\nNguyen, Louis L\neng\nComparative Study\nMeta-Analysis\nReview\n2015/07/28 06:00\nJ Vasc Surg. 2015 Aug;62(2):491-8. doi: 10.1016/j.jvs.2015.05.032.", "page" : "491-498", "title" : "Health-related quality-of-life outcomes after open versus endovascular abdominal aortic aneurysm repair", "type" : "article-journal", "volume" : "62" }, "uris" : [ "http://www.mendeley.com/documents/?uuid=5c882bb7-1ff6-4685-9756-eaeef26697b2" ] } ], "mendeley" : { "formattedCitation" : "227", "plainTextFormattedCitation" : "227", "previouslyFormattedCitation" : "227" }, "properties" : { }, "schema" : "https://github.com/citation-style-language/schema/raw/master/csl-citation.json" }227 EVAR provided better QOL than open repair for up to 1 year postoperatively. This advantage of EVAR was, however, lost at 2 years of follow-up.
The long-term results of the randomized DREAM trial also showed that EVAR is associated with less reduction of QOL in the short-term compared to open repair.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1002/bjs.10130", "ISBN" : "1365-2168 (Electronic)\r0007-1323 (Linking)", "PMID" : "27059152", "abstract" : "BACKGROUND: Long-term survival is similar after open or endovascular repair of abdominal aortic aneurysm. Few data exist on the effect of either procedure on long-term health-related quality of life (HRQoL) and health status. METHODS: Patients enrolled in a multicentre randomized clinical trial (DREAM trial; 2000-2003) in Europe of open repair versus endovascular repair (EVAR) of abdominal aortic aneurysm were asked to complete questionnaires on health status and HRQoL. HRQoL scores were assessed at baseline and at 13 time points thereafter, using generic tools, the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36(R)) and EuroQol 5D (EQ-5D). Physical (PCS) and mental component summary scores were also calculated. Follow-up was 5 years. RESULTS: Some 332 of 351 patients enrolled in the trial returned questionnaires. More than 70 per cent of questionnaires were returned at each time point. Both surgical interventions had a short-term negative effect on HRQoL and health status. This was less severe in the EVAR group than in the open repair group. In the longer term the physical domains of SF-36(R) favoured open repair: mean difference in PCS score between open repair and EVAR -1.98 (95 per cent c.i. -3.56 to -0.41). EQ-5D descriptive and EQ-5D visual analogue scale scores for open repair were also superior to those for EVAR after the initial 6-week interval: mean difference -0.06 (-0.10 to -0.02) and -4.09 (-6.91 to -1.27) respectively. CONCLUSION: In this study EVAR appeared to be associated with less severe disruption to HRQoL and health status in the short term. However, during longer-term follow-up to 5 years, patients receiving open repair appeared to have improved quality of life and health status.", "author" : [ { "dropping-particle" : "", "family" : "Bruin", "given" : "J L", "non-dropping-particle" : "de", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Groenwold", "given" : "R H", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Baas", "given" : "A F", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Brownrigg", "given" : "J R", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Prinssen", "given" : "M", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Grobbee", "given" : "D E", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Blankensteijn", "given" : "J D", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Group", "given" : "Dream Study", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Br J Surg", "id" : "ITEM-1", "issue" : "8", "issued" : { "date-parts" : [ [ "2016" ] ] }, "note" : "de Bruin, J L\nGroenwold, R H H\nBaas, A F\nBrownrigg, J R\nPrinssen, M\nGrobbee, D E\nBlankensteijn, J D\neng\nMulticenter Study\nRandomized Controlled Trial\nEngland\n2016/04/10 06:00\nBr J Surg. 2016 Jul;103(8):995-1002. doi: 10.1002/bjs.10130. Epub 2016 Apr 5.", "page" : "995-1002", "title" : "Quality of life from a randomized trial of open and endovascular repair for abdominal aortic aneurysm", "type" : "article-journal", "volume" : "103" }, "uris" : [ "http://www.mendeley.com/documents/?uuid=55a7919b-e537-43e1-805f-0718a37c390d" ] } ], "mendeley" : { "formattedCitation" : "228", "plainTextFormattedCitation" : "228", "previouslyFormattedCitation" : "228" }, "properties" : { }, "schema" : "https://github.com/citation-style-language/schema/raw/master/csl-citation.json" }228 Nevertheless, in the long-term (up to 5 years), QOL measures favored open repair. This might be partly related to the intensive follow-up protocol used for patients undergoing EVAR, which however is not routinely required for patients undergoing open repair. These patients keep remembering the existence of their AAA every time they go for surveillance and this might affect their self-reporting on QOL.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1002/bjs.10130", "ISBN" : "1365-2168 (Electronic)\r0007-1323 (Linking)", "PMID" : "27059152", "abstract" : "BACKGROUND: Long-term survival is similar after open or endovascular repair of abdominal aortic aneurysm. Few data exist on the effect of either procedure on long-term health-related quality of life (HRQoL) and health status. METHODS: Patients enrolled in a multicentre randomized clinical trial (DREAM trial; 2000-2003) in Europe of open repair versus endovascular repair (EVAR) of abdominal aortic aneurysm were asked to complete questionnaires on health status and HRQoL. HRQoL scores were assessed at baseline and at 13 time points thereafter, using generic tools, the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36(R)) and EuroQol 5D (EQ-5D). Physical (PCS) and mental component summary scores were also calculated. Follow-up was 5 years. RESULTS: Some 332 of 351 patients enrolled in the trial returned questionnaires. More than 70 per cent of questionnaires were returned at each time point. Both surgical interventions had a short-term negative effect on HRQoL and health status. This was less severe in the EVAR group than in the open repair group. In the longer term the physical domains of SF-36(R) favoured open repair: mean difference in PCS score between open repair and EVAR -1.98 (95 per cent c.i. -3.56 to -0.41). EQ-5D descriptive and EQ-5D visual analogue scale scores for open repair were also superior to those for EVAR after the initial 6-week interval: mean difference -0.06 (-0.10 to -0.02) and -4.09 (-6.91 to -1.27) respectively. CONCLUSION: In this study EVAR appeared to be associated with less severe disruption to HRQoL and health status in the short term. However, during longer-term follow-up to 5 years, patients receiving open repair appeared to have improved quality of life and health status.", "author" : [ { "dropping-particle" : "", "family" : "Bruin", "given" : "J L", "non-dropping-particle" : "de", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Groenwold", "given" : "R H", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Baas", "given" : "A F", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Brownrigg", "given" : "J R", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Prinssen", "given" : "M", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Grobbee", "given" : "D E", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Blankensteijn", "given" : "J D", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Group", "given" : "Dream Study", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Br J Surg", "id" : "ITEM-1", "issue" : "8", "issued" : { "date-parts" : [ [ "2016" ] ] }, "note" : "de Bruin, J L\nGroenwold, R H H\nBaas, A F\nBrownrigg, J R\nPrinssen, M\nGrobbee, D E\nBlankensteijn, J D\neng\nMulticenter Study\nRandomized Controlled Trial\nEngland\n2016/04/10 06:00\nBr J Surg. 2016 Jul;103(8):995-1002. doi: 10.1002/bjs.10130. Epub 2016 Apr 5.", "page" : "995-1002", "title" : "Quality of life from a randomized trial of open and endovascular repair for abdominal aortic aneurysm", "type" : "article-journal", "volume" : "103" }, "uris" : [ "http://www.mendeley.com/documents/?uuid=55a7919b-e537-43e1-805f-0718a37c390d" ] } ], "mendeley" : { "formattedCitation" : "228", "plainTextFormattedCitation" : "228", "previouslyFormattedCitation" : "228" }, "properties" : { }, "schema" : "https://github.com/citation-style-language/schema/raw/master/csl-citation.json" }228 Reinterventions are also more frequent after EVAR and this could also lead to an inferior QOL in the long-term compared to open repair. However, none of these studies have used questionnaires which are sensitive enough to detect changes in psychosocial functioning.
Reported QOL outcomes should be interpreted with caution due to the inherent subjectivity of patient-reporting outcomes. After open AAA repair patients are more willing to accept perioperative complications and discomfort, while after EVAR patients expect to recover quickly without major problems. Any diversion from such preoperative expectations can bias patient-reported QOL outcomes.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1002/bjs.10130", "ISBN" : "1365-2168 (Electronic)\r0007-1323 (Linking)", "PMID" : "27059152", "abstract" : "BACKGROUND: Long-term survival is similar after open or endovascular repair of abdominal aortic aneurysm. Few data exist on the effect of either procedure on long-term health-related quality of life (HRQoL) and health status. METHODS: Patients enrolled in a multicentre randomized clinical trial (DREAM trial; 2000-2003) in Europe of open repair versus endovascular repair (EVAR) of abdominal aortic aneurysm were asked to complete questionnaires on health status and HRQoL. HRQoL scores were assessed at baseline and at 13 time points thereafter, using generic tools, the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36(R)) and EuroQol 5D (EQ-5D). Physical (PCS) and mental component summary scores were also calculated. Follow-up was 5 years. RESULTS: Some 332 of 351 patients enrolled in the trial returned questionnaires. More than 70 per cent of questionnaires were returned at each time point. Both surgical interventions had a short-term negative effect on HRQoL and health status. This was less severe in the EVAR group than in the open repair group. In the longer term the physical domains of SF-36(R) favoured open repair: mean difference in PCS score between open repair and EVAR -1.98 (95 per cent c.i. -3.56 to -0.41). EQ-5D descriptive and EQ-5D visual analogue scale scores for open repair were also superior to those for EVAR after the initial 6-week interval: mean difference -0.06 (-0.10 to -0.02) and -4.09 (-6.91 to -1.27) respectively. CONCLUSION: In this study EVAR appeared to be associated with less severe disruption to HRQoL and health status in the short term. However, during longer-term follow-up to 5 years, patients receiving open repair appeared to have improved quality of life and health status.", "author" : [ { "dropping-particle" : "", "family" : "Bruin", "given" : "J L", "non-dropping-particle" : "de", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Groenwold", "given" : "R H", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Baas", "given" : "A F", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Brownrigg", "given" : "J R", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Prinssen", "given" : "M", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Grobbee", "given" : "D E", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Blankensteijn", "given" : "J D", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Group", "given" : "Dream Study", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Br J Surg", "id" : "ITEM-1", "issue" : "8", "issued" : { "date-parts" : [ [ "2016" ] ] }, "note" : "de Bruin, J L\nGroenwold, R H H\nBaas, A F\nBrownrigg, J R\nPrinssen, M\nGrobbee, D E\nBlankensteijn, J D\neng\nMulticenter Study\nRandomized Controlled Trial\nEngland\n2016/04/10 06:00\nBr J Surg. 2016 Jul;103(8):995-1002. doi: 10.1002/bjs.10130. Epub 2016 Apr 5.", "page" : "995-1002", "title" : "Quality of life from a randomized trial of open and endovascular repair for abdominal aortic aneurysm", "type" : "article-journal", "volume" : "103" }, "uris" : [ "http://www.mendeley.com/documents/?uuid=55a7919b-e537-43e1-805f-0718a37c390d" ] } ], "mendeley" : { "formattedCitation" : "228", "plainTextFormattedCitation" : "228", "previouslyFormattedCitation" : "228" }, "properties" : { }, "schema" : "https://github.com/citation-style-language/schema/raw/master/csl-citation.json" }228
[H1] Outlook
AAA is an increasingly important disease, since a growing number of patients are diagnosed and treated. This depends on the ageing population, and the advent of EVAR has also extended the number of patients, even elderly, that are eligible for elective AAA repair.
Since 2000, there have been several developments in the management of AAA. Furthermore, a large body of research has been accumulated into the risk factors and pathophysiology of AAA and potential non-surgical therapies. The place of minimally invasive EVAR for both elective and emergency cases has been substantiated by several randomized trials and meta-analyses of these trials. These same trials, together with other evidence, also have exposed some of the weaknesses of EVAR, the rather poor long-term durability compared with open surgical repair, the potential need for lifelong surveillance (no quick operation and cure) and the limited applicability of this newer technique to women. Ongoing research and development programs are addressing these issues, using advances in materials science. The alternative approach of EVAS remains under evaluation. Controversy is widespread concerning the operative management of aneurysms which extend close to or above the renal arteries, including how endovascular techniques should be modified or adapted for these complex aneurysms. Other problems which remain to be addressed include reducing the morbidity and mortality from AAA in women and ethnic minorities.
Patients diagnosed with smaller AAA will be subjected to continuous surveillance, commonly with ultrasonography, until elective repair is considered. Since small AAA are common and readily detected by non-invasive, low-cost ultrasonography screening, a major goal remains finding therapeutic agents which will prevent further AAA growth and the need for any future operative repair (FIG. 8).
Experimental animal studies have provided many new leads, particularly in cell signaling pathways, often with very effective functional imaging modalities and targeted treatments in these animal models. Most of these are small animal models where AAA induction is rapid and not dependent on smoking (in sharp contrast to the indolent course of small AAA in humans, where smoking remains the most important risk factor) and many times bias has been introduced by lack of adequate observer blinding, insufficient animals in experimental groups or using only one of the available animal models.
Although GWAS studies and other molecular research have identified genetic variants and a set of genes associated to the development of AAA, translational research aimed at producing effective drugs to limit small AAA growth is limited. New epidemiological studies have suggested other new therapeutic targets or drugs to limit the progression of small AAA, but none of these has yet been shown to be effective in properly conducted randomized trials. For AAA, the field of translational biology, together with other technologies (e.g., nanotechnology) remains wide open. The parallel of thoracic aortic aneurysms and dissections provides insight into why the genetic and basic science research on AAA in man must continue. For thoracic aortic aneurysms and dissections , major causal genes have been identified together with associated pivotal signaling pathways, which have allowed effective targeted pharmacological therapies to be developed and validated in randomized trials. AAAs are much more common than thoracic aortic aneurysms and dissections and the need for further genetic and basic science research to develop effective novel therapeutic approaches for AAA remains urgent. Pharmacological therapy for AAA is unlikely to be limited to the target of preventing small aneurysm growth. Additional targets include prevention of distal and proximal aneurysm extension following surgical correction and reducing the risk of aneurysm rupture in those with large AAA who are not considered candidates for AAA repair.
In summary, whatever the safety of present-day interventions to prophylactically repair AAAs, they are not without a certain early mortality (at best 1-2%), not without morbidity, nor without consequences for long-term health and health costs. A better knowledge of the epidemiology of AAAs in ageing populations, their growth rate and the true incidence of rupture, together with demonstration of genetic mechanisms and the elucidation of the biochemical, cellular and immunological pathways by which heredity and risk factors are expressed, will provide us with a comprehensive approach for a better management of AAAs. The knowledge that we seek to discover will permit us, in the future, to achieve better outcomes for AAA repair and to develop new, effective, prophylactic chemotherapies.
Box 1. Mycotic AAA
Mycotic aortic aneurysm is somewhat of a misnomer, since fungal infections rarely cause aneurysms or contribute to their growth, but rather should be called infectious aneurysms, predominantly caused by bacteria. It is more commonly seen in Asian than in Western populations. Historically syphilis was the cause of many mycotic AAAs, but other pathogens, such as salmonella, are more common in a modern vascular service, where the aortic wall is susceptible to colonization by circulating bacteria, from endocarditis or urinary tract infections.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1016/j.jvs.2007.07.025", "ISBN" : "0741-5214 (Print)\r0741-5214 (Linking)", "PMID" : "17905558", "abstract" : "BACKGROUND: Surgical treatment for mycotic aortic aneurysms is not optimal. Even with a large excision, extensive debridement, in situ or extra-anatomical reconstruction, and with or without lifelong antibiotic treatment, mycotic aneurysms still carry very high mortality and morbidity. The use of endovascular aneurysm repair (EVAR) for mycotic aortic aneurysms simplifies the procedure and provides a good alternative for this critical condition. However, the question remains: if EVAR is placed in an infected bed, what is the outcome of the infection? Does it heal, become aggravated, or even cause a disastrous aortic rupture? In this study, we tried to clarify the risk factors for such an adverse response. METHODS: A literature review was undertaken by using MEDLINE. All relevant reports on endoluminal management of mycotic aortic aneurysms were included. Logistic regressions were applied to identify predictors of persistent infection. RESULTS: A total of 48 cases from 22 reports were included. The life-table analysis showed that the 30-day survival rate was 89.6% +/- 4.4%, and the 2-year survival rate was 82.2% +/- 5.8%. By univariate analysis, age 65 years or older, rupture of the aneurysm (including those with aortoenteric fistula and aortobronchial fistula), and fever at the time of operation were identified as significant predictors of persistent infection, and preoperative use of antibiotics for longer than 1 week and an adjunct procedure combined with EVAR were identified as significant protective factors for persistent infection. However, by multivariate logistic regression analysis, the only significant independent predictors identified were rupture of aneurysm and fever. CONCLUSIONS: EVAR seems a possible alternative method for treating mycotic aortic aneurysms. Identification of the risk factors for persistent infection may help to decrease surgical morbidity and mortality. EVAR could be used as a temporary measure; however, a definite surgical treatment should be considered for patients present with aneurysm rupture or fever.", "author" : [ { "dropping-particle" : "", "family" : "Kan", "given" : "C D", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Lee", "given" : "H L", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Yang", "given" : "Y J", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "J Vasc Surg", "id" : "ITEM-1", "issue" : "5", "issued" : { "date-parts" : [ [ "2007" ] ] }, "note" : "Kan, Chung-Dann\nLee, Hsin-Ling\nYang, Yu-Jen\neng\nReview\n2007/10/02 09:00\nJ Vasc Surg. 2007 Nov;46(5):906-12. doi: 10.1016/j.jvs.2007.07.025. Epub 2007 Oct 1.", "page" : "906-912", "title" : "Outcome after endovascular stent graft treatment for mycotic aortic aneurysm: a systematic review", "type" : "article-journal", "volume" : "46" }, "uris" : [ "http://www.mendeley.com/documents/?uuid=6f5c50e9-45a8-4136-a5c0-d20446a7e807" ] }, { "id" : "ITEM-2", "itemData" : { "DOI" : "10.23736/S0021-9509.17.10069-8", "ISBN" : "1827-191X (Electronic)\r0021-9509 (Linking)", "PMID" : "28627863", "abstract" : "Treatment of mycotic aortic aneurysms (MAAs) composes a particularly difficult challenge. Open repair has been considered the gold standard, despite lack of evidence supporting its superiority compared with the emerging alternative endovascular aortic repair (EVAR). This review discusses the pros and cons of EVAR for MAAs by dissecting the three largest publications on MAAs, and concludes that there has been a paradigm shift in treatment of MAAs for the benefit of EVAR.", "author" : [ { "dropping-particle" : "", "family" : "Sorelius", "given" : "K", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Mani", "given" : "K", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Bjorck", "given" : "M", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Wanhainen", "given" : "A", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "J Cardiovasc Surg (Torino)", "id" : "ITEM-2", "issue" : "6", "issued" : { "date-parts" : [ [ "2017" ] ] }, "note" : "Sorelius, Karl\nMani, Kevin\nBjorck, Martin\nWanhainen, Anders\neng\nReview\nItaly\n2017/06/20 06:00\nJ Cardiovasc Surg (Torino). 2017 Dec;58(6):870-874. doi: 10.23736/S0021-9509.17.10069-8. Epub 2017 Jun 19.", "page" : "870-874", "title" : "Endovascular treatment of mycotic aortic aneurysms: a paradigm shift", "type" : "article-journal", "volume" : "58" }, "uris" : [ "http://www.mendeley.com/documents/?uuid=6121a1b7-f875-41fb-8983-11fea50ea65a" ] } ], "mendeley" : { "formattedCitation" : "108,109", "plainTextFormattedCitation" : "108,109", "previouslyFormattedCitation" : "108,109" }, "properties" : { }, "schema" : "https://github.com/citation-style-language/schema/raw/master/csl-citation.json" }108,109
Much remains unknown on the pathogenesis of mycotic AAA, but possibly there can be an underlying vulnerable lesion or plaque in the wall, where the infection commences. A subsequent proteolysis of the wall is triggered, and an aneurysmal dilatation develops.
A mycotic AAA occurs as commonly in the thoracic as in the infrarenal aorta, and is more often saccular than fusiform. The type of bacteria differs based on geographic location, with a somewhat more diverse pattern in Europe and the US (30% staphylococcus, 11% streptococcus, 7-10% E. coli) compared to Asia (60% salmonella).ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "ISBN" : "1011-6842 (Print)\r1011-6842 (Linking)", "PMID" : "27122829", "abstract" : "PURPOSE: Infected aneurysm of the aorta and adjacent arteries is rarely occurring and can be fatal without surgical intervention. Within the medical community, the most efficacious treatment strategy to address infected aortic aneurysm remains controversial. In this study, we have reviewed our treatment experience with 109 patients. METHODS: We included in our study all consecutive patients treated for primary infected aortic aneurysm at our facility between 1995 and 2011. Aneurysm-related mortality was defined as the presence of in-hospital and late mortality related to infection or postoperative complications. RESULTS: The median patient age was 72 years (range, 35-88), and 87 (80%) were male. Pathogen was isolated in 101 patients, and the most common microorganism identified was non-typhoid Salmonella in 61 (60%), followed by Staphylococcus aureus in 16 (16%) and Streptococci species in 7 (7%). Eighty-five (78%) patients underwent surgical treatment. Surgery included open repair with in-situ graft replacement in 77 (71%) and endovascular repair in 8 (7%). The aneurysm-related mortality rate was 67% in medically treated and 21% in surgically treated patients, with a median follow-up duration of 31.5 months (range 1-189). Additionally, risk factors for aneurysm-related mortality included old age, chronic lung disease, psoas muscle abscess, short duration of preoperative antibiotics, no operation, and probably endovascular repair. CONCLUSIONS: Non-typhoid Salmonella was the most common pathogen found in our study group patients with infected aortic aneurysm. It appears that prolonged preoperative antibiotic treatment followed by open in-situ graft replacement remains the preferred and most effective treatment strategy. KEY WORDS: Infected aortic aneurysm; Outcome; Pathogen; Surgery.", "author" : [ { "dropping-particle" : "", "family" : "Lin", "given" : "C H", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Hsu", "given" : "R B", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Acta Cardiol Sin", "id" : "ITEM-1", "issue" : "6", "issued" : { "date-parts" : [ [ "2014" ] ] }, "note" : "Lin, Cheng-Hsin\nHsu, Ron-Bin\neng\nChina (Republic : 1949- )\n2014/11/01 00:00\nActa Cardiol Sin. 2014 Nov;30(6):514-21.", "page" : "514-521", "title" : "Primary Infected Aortic Aneurysm: Clinical Presentation, Pathogen, and Outcome", "type" : "article-journal", "volume" : "30" }, "uris" : [ "http://www.mendeley.com/documents/?uuid=25c3a07b-828f-419c-8a65-54c5d8d92311" ] } ], "mendeley" : { "formattedCitation" : "110", "plainTextFormattedCitation" : "110", "previouslyFormattedCitation" : "110" }, "properties" : { }, "schema" : "https://github.com/citation-style-language/schema/raw/master/csl-citation.json" }110 In 20-30% of diagnosed patients the pathogen has not been determined.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "ISBN" : "1011-6842 (Print)\r1011-6842 (Linking)", "PMID" : "27122829", "abstract" : "PURPOSE: Infected aneurysm of the aorta and adjacent arteries is rarely occurring and can be fatal without surgical intervention. Within the medical community, the most efficacious treatment strategy to address infected aortic aneurysm remains controversial. In this study, we have reviewed our treatment experience with 109 patients. METHODS: We included in our study all consecutive patients treated for primary infected aortic aneurysm at our facility between 1995 and 2011. Aneurysm-related mortality was defined as the presence of in-hospital and late mortality related to infection or postoperative complications. RESULTS: The median patient age was 72 years (range, 35-88), and 87 (80%) were male. Pathogen was isolated in 101 patients, and the most common microorganism identified was non-typhoid Salmonella in 61 (60%), followed by Staphylococcus aureus in 16 (16%) and Streptococci species in 7 (7%). Eighty-five (78%) patients underwent surgical treatment. Surgery included open repair with in-situ graft replacement in 77 (71%) and endovascular repair in 8 (7%). The aneurysm-related mortality rate was 67% in medically treated and 21% in surgically treated patients, with a median follow-up duration of 31.5 months (range 1-189). Additionally, risk factors for aneurysm-related mortality included old age, chronic lung disease, psoas muscle abscess, short duration of preoperative antibiotics, no operation, and probably endovascular repair. CONCLUSIONS: Non-typhoid Salmonella was the most common pathogen found in our study group patients with infected aortic aneurysm. It appears that prolonged preoperative antibiotic treatment followed by open in-situ graft replacement remains the preferred and most effective treatment strategy. KEY WORDS: Infected aortic aneurysm; Outcome; Pathogen; Surgery.", "author" : [ { "dropping-particle" : "", "family" : "Lin", "given" : "C H", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Hsu", "given" : "R B", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Acta Cardiol Sin", "id" : "ITEM-1", "issue" : "6", "issued" : { "date-parts" : [ [ "2014" ] ] }, "note" : "Lin, Cheng-Hsin\nHsu, Ron-Bin\neng\nChina (Republic : 1949- )\n2014/11/01 00:00\nActa Cardiol Sin. 2014 Nov;30(6):514-21.", "page" : "514-521", "title" : "Primary Infected Aortic Aneurysm: Clinical Presentation, Pathogen, and Outcome", "type" : "article-journal", "volume" : "30" }, "uris" : [ "http://www.mendeley.com/documents/?uuid=25c3a07b-828f-419c-8a65-54c5d8d92311" ] }, { "id" : "ITEM-2", "itemData" : { "DOI" : "10.1067/mva.2001.118084", "ISBN" : "0741-5214 (Print)\r0741-5214 (Linking)", "PMID" : "11700493", "abstract" : "OBJECTIVE: Infected aortic aneurysms are rare, difficult to treat, and associated with significant morbidity. The purpose of this study was to review the management and results of patients with infected aortic aneurysms and identify clinical variables associated with poor outcome. METHODS: The clinical data and early and late outcomes of 43 patients treated for infected aortic aneurysms during a 25-year period (1976-2000) were reviewed. Variables were correlated with risk of aneurysm-related death and vascular complications, defined as organ or limb ischemia, graft infection or occlusion, and anastomotic or recurrent aneurysm. RESULTS: Infected aneurysms were infrarenal in only 40% of cases. Seventy percent of patients were immunocompromised hosts. Ninety-three percent had symptoms, and 53% had ruptured aneurysms. Surgical treatment was in situ aortic grafting (35) and extra-anatomic bypass (6). Operative mortality was 21% (9/42). Early vascular complications included ischemic colitis (3), anastomotic disruption (1), peripheral embolism (1), paraplegia (1), and monoparesis (1). Late vascular complications included graft infection (2), recurrent aneurysm (2), limb ischemia (1), and limb occlusion (1). Mean follow-up was 4.3 years. Cumulative survival rates at 1 year and 5 years were 82% and 50%, respectively, significantly lower than survival rates for the general population (96% and 81%) and for the noninfected aortic aneurysm cohort (91% and 69%) at same intervals. Rate of survival free of late graft-related complications was 90% at 1 year and 5 years, similar to that reported for patients who had repair of noninfected abdominal aortic aneurysms (97% and 92%). Variables associated with increased risk of aneurysm-related death included extensive periaortic infection, female sex, Staphylococcus aureus infection, aneurysm rupture, and suprarenal aneurysm location (P <.05). For risk of vascular complications, extensive periaortic infection, female sex, leukocytosis, and hemodynamic instability were positively associated (P <.05). CONCLUSION: Infected aortic aneurysms have an aggressive presentation and a complicated early outcome. However, late outcome is surprisingly favorable, with no aneurysm-related deaths and a low graft-related complication rate, similar to standard aneurysm repair. In situ aortic grafting is a safe and durable option in most patients.", "author" : [ { "dropping-particle" : "", "family" : "Oderich", "given" : "G S", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Panneton", "given" : "J M", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Bower", "given" : "T C", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Cherry Jr.", "given" : "K J", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Rowland", "given" : "C M", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Noel", "given" : "A A", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Hallett Jr.", "given" : "J W", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Gloviczki", "given" : "P", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "J Vasc Surg", "id" : "ITEM-2", "issue" : "5", "issued" : { "date-parts" : [ [ "2001" ] ] }, "note" : "Oderich, G S\nPanneton, J M\nBower, T C\nCherry, K J Jr\nRowland, C M\nNoel, A A\nHallett, J W Jr\nGloviczki, P\neng\n2001/11/09 10:00\nJ Vasc Surg. 2001 Nov;34(5):900-8. doi: 10.1067/mva.2001.118084.", "page" : "900-908", "title" : "Infected aortic aneurysms: aggressive presentation, complicated early outcome, but durable results", "type" : "article-journal", "volume" : "34" }, "uris" : [ "http://www.mendeley.com/documents/?uuid=a39bdf48-86c6-451f-8493-75fb56a9a6ea" ] } ], "mendeley" : { "formattedCitation" : "110,111", "plainTextFormattedCitation" : "110,111", "previouslyFormattedCitation" : "110,111" }, "properties" : { }, "schema" : "https://github.com/citation-style-language/schema/raw/master/csl-citation.json" }110,111 The patients are often elderly and have several other comorbid conditions, such as diabetes mellitus, renal insufficiency, or HIV infection.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1067/mva.2001.118084", "ISBN" : "0741-5214 (Print)\r0741-5214 (Linking)", "PMID" : "11700493", "abstract" : "OBJECTIVE: Infected aortic aneurysms are rare, difficult to treat, and associated with significant morbidity. The purpose of this study was to review the management and results of patients with infected aortic aneurysms and identify clinical variables associated with poor outcome. METHODS: The clinical data and early and late outcomes of 43 patients treated for infected aortic aneurysms during a 25-year period (1976-2000) were reviewed. Variables were correlated with risk of aneurysm-related death and vascular complications, defined as organ or limb ischemia, graft infection or occlusion, and anastomotic or recurrent aneurysm. RESULTS: Infected aneurysms were infrarenal in only 40% of cases. Seventy percent of patients were immunocompromised hosts. Ninety-three percent had symptoms, and 53% had ruptured aneurysms. Surgical treatment was in situ aortic grafting (35) and extra-anatomic bypass (6). Operative mortality was 21% (9/42). Early vascular complications included ischemic colitis (3), anastomotic disruption (1), peripheral embolism (1), paraplegia (1), and monoparesis (1). Late vascular complications included graft infection (2), recurrent aneurysm (2), limb ischemia (1), and limb occlusion (1). Mean follow-up was 4.3 years. Cumulative survival rates at 1 year and 5 years were 82% and 50%, respectively, significantly lower than survival rates for the general population (96% and 81%) and for the noninfected aortic aneurysm cohort (91% and 69%) at same intervals. Rate of survival free of late graft-related complications was 90% at 1 year and 5 years, similar to that reported for patients who had repair of noninfected abdominal aortic aneurysms (97% and 92%). Variables associated with increased risk of aneurysm-related death included extensive periaortic infection, female sex, Staphylococcus aureus infection, aneurysm rupture, and suprarenal aneurysm location (P <.05). For risk of vascular complications, extensive periaortic infection, female sex, leukocytosis, and hemodynamic instability were positively associated (P <.05). CONCLUSION: Infected aortic aneurysms have an aggressive presentation and a complicated early outcome. However, late outcome is surprisingly favorable, with no aneurysm-related deaths and a low graft-related complication rate, similar to standard aneurysm repair. In situ aortic grafting is a safe and durable option in most patients.", "author" : [ { "dropping-particle" : "", "family" : "Oderich", "given" : "G S", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Panneton", "given" : "J M", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Bower", "given" : "T C", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Cherry Jr.", "given" : "K J", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Rowland", "given" : "C M", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Noel", "given" : "A A", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Hallett Jr.", "given" : "J W", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Gloviczki", "given" : "P", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "J Vasc Surg", "id" : "ITEM-1", "issue" : "5", "issued" : { "date-parts" : [ [ "2001" ] ] }, "note" : "Oderich, G S\nPanneton, J M\nBower, T C\nCherry, K J Jr\nRowland, C M\nNoel, A A\nHallett, J W Jr\nGloviczki, P\neng\n2001/11/09 10:00\nJ Vasc Surg. 2001 Nov;34(5):900-8. doi: 10.1067/mva.2001.118084.", "page" : "900-908", "title" : "Infected aortic aneurysms: aggressive presentation, complicated early outcome, but durable results", "type" : "article-journal", "volume" : "34" }, "uris" : [ "http://www.mendeley.com/documents/?uuid=a39bdf48-86c6-451f-8493-75fb56a9a6ea" ] }, { "id" : "ITEM-2", "itemData" : { "DOI" : "10.1016/j.jvs.2011.07.077", "ISBN" : "1097-6809 (Electronic)\r0741-5214 (Linking)", "PMID" : "22051868", "abstract" : "BACKGROUND: Open surgical treatment for an infected aortic aneurysm has a high rate of surgical morbidity and mortality and does not guarantee eradication of the infected nidus. The use of endovascular aortic repair (EVAR) might simplify the procedure and provide a good alternative for this critical condition, but this remains to be proved. This study assessed the efficacy and outcome of EVAR with an adjunctive antibiotic treatment strategy. METHODS: We focused on the experiences and results of the management of infected aortic aneurysms with positive blood cultures. We drew the blood for culture study, immediately prescribed broad-spectrum antibiotics, performed EVAR procedures, and followed this with sensitive antibiotics and adjunctive procedures. RESULTS: Twelve consecutive patients (mean age, 70 years) were included in this EVAR strategy. Three patients had thoracic, two thoracoabdominal, and the remaining seven had infected abdominal aneurysms. Ten Salmonella, one Staphylococcus, and one Streptococcus spp were identified. There was no hospital death. Three patients underwent computed tomography (CT)-guided drainage, and one underwent open laparotomy debridement. Mean follow-up was 24 months. One late death occurred but was unrelated to reinfection. All patients seemed well, with no evidence of EVAR graft infection at a mean follow-up of 23.6 months. CONCLUSIONS: This small multi-institutional study summarizing the experiences of patients with an infected aortic aneurysm managed by EVAR and an aggressive antibiotic strategy revealed that this EVAR strategy might be a suitable approach to treating this disease. These favorable results may be typical for Salmonella infection, which was present in most of the patients. Further experience is needed to assess whether this therapeutic strategy works equally well in aneurysm infection caused by other organisms.", "author" : [ { "dropping-particle" : "", "family" : "Kan", "given" : "C D", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Yen", "given" : "H T", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Kan", "given" : "C B", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Yang", "given" : "Y J", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "J Vasc Surg", "id" : "ITEM-2", "issue" : "1", "issued" : { "date-parts" : [ [ "2012" ] ] }, "note" : "Kan, Chung-Dann\nYen, Hsu-Ting\nKan, Chung-Ben\nYang, Yu-Jen\neng\nMulticenter Study\n2011/11/05 06:00\nJ Vasc Surg. 2012 Jan;55(1):55-60. doi: 10.1016/j.jvs.2011.07.077. Epub 2011 Nov 1.", "page" : "55-60", "title" : "The feasibility of endovascular aortic repair strategy in treating infected aortic aneurysms", "type" : "article-journal", "volume" : "55" }, "uris" : [ "http://www.mendeley.com/documents/?uuid=5c9718f5-3681-4162-ab32-92a7ec77ce58" ] }, { "id" : "ITEM-3", "itemData" : { "DOI" : "10.1161/CIRCULATIONAHA.114.009481", "ISBN" : "1524-4539 (Electronic)\r0009-7322 (Linking)", "PMID" : "25378548", "abstract" : "BACKGROUND: Mycotic aortic aneurysm (MAA) is a rare and life-threatening disease. The aim of this European multicenter collaboration was to study the durability of endovascular aortic repair (EVAR) of MAA, by assessing late infection-related complications and long-term survival. METHODS AND RESULTS: All EVAR treated MAAs, between 1999 and 2013 at 16 European centers, were retrospectively reviewed. One hundred twenty-three patients with 130 MAAs were identified. Mean age was 69 years (range 39-86), 87 (71%) were men, 58 (47%) had immunodeficiency, and 47 (38%) presented with rupture. Anatomic locations were ascending/arch (n=4), descending (n=34), paravisceral (n=15), infrarenal aorta (n=63), and multiple (n=7). Treatments were thoracic EVAR (n=43), fenestrated/branched EVAR (n=9), and infrarenal EVAR (n=71). Antibiotic was administered for mean 30 weeks. Mean follow-up was 35 months (range 1 week to 149 months). Six patients (5%) were converted to open repair during follow-up. Survival was 91% (95% confidence interval, 86% to 96%), 75% (67% to 83%), 55% (44% to 66%), and 41% (28% to 54%) after 1, 12, 60, and 120 months, respectively. Infection-related death occurred in 23 patients (19%), 9 after discontinuation of antibiotic treatment. A Cox regression analysis demonstrated non-Salmonella-positive culture as predictors for late infection-related death. CONCLUSIONS: Endovascular treatment of MAA is feasible and for most patients a durable treatment option. Late infections do occur, are often lethal, and warrant long-term antibiotic treatment and follow-up. Patients with non-Salmonella-positive blood cultures were more likely to die from late infection.", "author" : [ { "dropping-particle" : "", "family" : "Sorelius", "given" : "K", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Mani", "given" : "K", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Bjorck", "given" : "M", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Sedivy", "given" : "P", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Wahlgren", "given" : "C M", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Taylor", "given" : "P", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Clough", "given" : "R E", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Lyons", "given" : "O", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Thompson", "given" : "M", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Brownrigg", "given" : "J", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Ivancev", "given" : "K", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Davis", "given" : "M", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Jenkins", "given" : "M P", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Jaffer", "given" : "U", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Bown", "given" : "M", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Rancic", "given" : "Z", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Mayer", "given" : "D", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Brunkwall", "given" : "J", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Gawenda", "given" : "M", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Kolbel", "given" : "T", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Jean-Baptiste", "given" : "E", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Moll", "given" : "F", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Berger", "given" : "P", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Liapis", "given" : "C D", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Moulakakis", "given" : "K G", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Langenskiold", "given" : "M", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Roos", "given" : "H", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Larzon", "given" : "T", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Pirouzram", "given" : "A", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Wanhainen", "given" : "A", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "European", "given" : "M A A collaborators", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Circulation", "id" : "ITEM-3", "issue" : "24", "issued" : { "date-parts" : [ [ "2014" ] ] }, "note" : "Sorelius, Karl\nMani, Kevin\nBjorck, Martin\nSedivy, Petr\nWahlgren, Carl-Magnus\nTaylor, Peter\nClough, Rachel E\nLyons, Oliver\nThompson, Matt\nBrownrigg, Jack\nIvancev, Krassi\nDavis, Meryl\nJenkins, Michael P\nJaffer, Usman\nBown, Matt\nRancic, Zoran\nMayer, Dieter\nBrunkwall, Jan\nGawenda, Michael\nKolbel, Tilo\nJean-Baptiste, Elixene\nMoll, Frans\nBerger, Paul\nLiapis, Christos D\nMoulakakis, Konstantinos G\nLangenskiold, Marcus\nRoos, Hakan\nLarzon, Thomas\nPirouzram, Artai\nWanhainen, Anders\neng\nG1000327/Medical Research Council/United Kingdom\nMulticenter Study\n2014/11/08 06:00\nCirculation. 2014 Dec 9;130(24):2136-42. doi: 10.1161/CIRCULATIONAHA.114.009481. Epub 2014 Nov 5.", "page" : "2136-2142", "title" : "Endovascular treatment of mycotic aortic aneurysms: a European multicenter study", "type" : "article-journal", "volume" : "130" }, "uris" : [ "http://www.mendeley.com/documents/?uuid=b5cd9fbb-81e9-4a21-9652-2cdd3dee6586" ] }, { "id" : "ITEM-4", "itemData" : { "DOI" : "10.1016/j.jvs.2008.08.004", "ISBN" : "1097-6809 (Electronic)\r0741-5214 (Linking)", "PMID" : "18848757", "abstract" : "BACKGROUND: Infected aneurysm of the aorta is almost always fatal without undergoing aortic resection. Medical treatment was attempted selectively in patients who were considered too high risk for surgery. We review our experience with 22 patients treated without undergoing aortic resection over 12 years. METHODS: Retrospective chart review. RESULTS: Between 1995 and 2007, 22 cases of infected aortic aneurysms treated without undergoing aortic resection during the first admission were included. There were 17 men with a median age of 76 years (range, 35 to 88 years). Of 18 pathogens isolated, the most common responsible microorganism was nontyphoid Salmonella in 11 followed by Staphylococcus aureus in five. The site of infection was thoracic in eight and abdominal in 14. The hospital mortality rate was 50%, and the aneurysm-related mortality rate after long-term follow-up was 59%. The event-free survival rate at one year was 32%. Of 11 patients with Salmonella infection, eight patients have lived beyond 30 days and six were event-free after one year. Of 11 patients with non-Salmonella, four patients have lived beyond 30 days and only one was event-free after one year. The overall aneurysm-related mortality rate was 36% in Salmonella infected patients and 82% in non-Salmonella infected patients. CONCLUSION: Clinical results of medical treatment using current antibiotics in patients with infected aortic aneurysm were poor. Traditional surgical excision of infected aortic aneurysms with revascularization remains the gold standard and should be attempted except in high risk patients.", "author" : [ { "dropping-particle" : "", "family" : "Hsu", "given" : "R B", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Chang", "given" : "C I", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Wu", "given" : "I H", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Lin", "given" : "F Y", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "J Vasc Surg", "id" : "ITEM-4", "issue" : "1", "issued" : { "date-parts" : [ [ "2009" ] ] }, "note" : "Hsu, Ron-Bin\nChang, Chung-I\nWu, I-Hui\nLin, Fang-Yue\neng\n2008/10/14 09:00\nJ Vasc Surg. 2009 Jan;49(1):66-70. doi: 10.1016/j.jvs.2008.08.004. Epub 2008 Oct 11.", "page" : "66-70", "title" : "Selective medical treatment of infected aneurysms of the aorta in high risk patients", "type" : "article-journal", "volume" : "49" }, "uris" : [ "http://www.mendeley.com/documents/?uuid=8f799f4d-203c-4651-b4dc-bb80be3727e2" ] } ], "mendeley" : { "formattedCitation" : "111\u2013114", "plainTextFormattedCitation" : "111\u2013114", "previouslyFormattedCitation" : "111\u2013114" }, "properties" : { }, "schema" : "https://github.com/citation-style-language/schema/raw/master/csl-citation.json" }111114 Patients with mycotic AAA have a high mortality, and they can develop a fistula, an erosive process between their aorta and bowel (aorto-enteric fistula) commonly causing gastrointestinal bleeding and anemia, and an extremely poor prognosis.
The only curative treatment for mycotic AAAs is surgical, by local resection of the aneurysm, and commonly an extra-anatomic by-pass, such as axillofemoral by-pass or an in situ reconstruction of the aorta by a vein graft (NAIS, neoaortoiliac system). The increasing use of EVAR in this patient group is debated, but should probably be accompanied with a longer preoperative use of antibiotics, possibly life-long.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1016/j.jvs.2011.07.077", "ISBN" : "1097-6809 (Electronic)\r0741-5214 (Linking)", "PMID" : "22051868", "abstract" : "BACKGROUND: Open surgical treatment for an infected aortic aneurysm has a high rate of surgical morbidity and mortality and does not guarantee eradication of the infected nidus. The use of endovascular aortic repair (EVAR) might simplify the procedure and provide a good alternative for this critical condition, but this remains to be proved. This study assessed the efficacy and outcome of EVAR with an adjunctive antibiotic treatment strategy. METHODS: We focused on the experiences and results of the management of infected aortic aneurysms with positive blood cultures. We drew the blood for culture study, immediately prescribed broad-spectrum antibiotics, performed EVAR procedures, and followed this with sensitive antibiotics and adjunctive procedures. RESULTS: Twelve consecutive patients (mean age, 70 years) were included in this EVAR strategy. Three patients had thoracic, two thoracoabdominal, and the remaining seven had infected abdominal aneurysms. Ten Salmonella, one Staphylococcus, and one Streptococcus spp were identified. There was no hospital death. Three patients underwent computed tomography (CT)-guided drainage, and one underwent open laparotomy debridement. Mean follow-up was 24 months. One late death occurred but was unrelated to reinfection. All patients seemed well, with no evidence of EVAR graft infection at a mean follow-up of 23.6 months. CONCLUSIONS: This small multi-institutional study summarizing the experiences of patients with an infected aortic aneurysm managed by EVAR and an aggressive antibiotic strategy revealed that this EVAR strategy might be a suitable approach to treating this disease. These favorable results may be typical for Salmonella infection, which was present in most of the patients. Further experience is needed to assess whether this therapeutic strategy works equally well in aneurysm infection caused by other organisms.", "author" : [ { "dropping-particle" : "", "family" : "Kan", "given" : "C D", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Yen", "given" : "H T", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Kan", "given" : "C B", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Yang", "given" : "Y J", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "J Vasc Surg", "id" : "ITEM-1", "issue" : "1", "issued" : { "date-parts" : [ [ "2012" ] ] }, "note" : "Kan, Chung-Dann\nYen, Hsu-Ting\nKan, Chung-Ben\nYang, Yu-Jen\neng\nMulticenter Study\n2011/11/05 06:00\nJ Vasc Surg. 2012 Jan;55(1):55-60. doi: 10.1016/j.jvs.2011.07.077. Epub 2011 Nov 1.", "page" : "55-60", "title" : "The feasibility of endovascular aortic repair strategy in treating infected aortic aneurysms", "type" : "article-journal", "volume" : "55" }, "uris" : [ "http://www.mendeley.com/documents/?uuid=5c9718f5-3681-4162-ab32-92a7ec77ce58" ] }, { "id" : "ITEM-2", "itemData" : { "DOI" : "10.1067/mva.2001.118084", "ISBN" : "0741-5214 (Print)\r0741-5214 (Linking)", "PMID" : "11700493", "abstract" : "OBJECTIVE: Infected aortic aneurysms are rare, difficult to treat, and associated with significant morbidity. The purpose of this study was to review the management and results of patients with infected aortic aneurysms and identify clinical variables associated with poor outcome. METHODS: The clinical data and early and late outcomes of 43 patients treated for infected aortic aneurysms during a 25-year period (1976-2000) were reviewed. Variables were correlated with risk of aneurysm-related death and vascular complications, defined as organ or limb ischemia, graft infection or occlusion, and anastomotic or recurrent aneurysm. RESULTS: Infected aneurysms were infrarenal in only 40% of cases. Seventy percent of patients were immunocompromised hosts. Ninety-three percent had symptoms, and 53% had ruptured aneurysms. Surgical treatment was in situ aortic grafting (35) and extra-anatomic bypass (6). Operative mortality was 21% (9/42). Early vascular complications included ischemic colitis (3), anastomotic disruption (1), peripheral embolism (1), paraplegia (1), and monoparesis (1). Late vascular complications included graft infection (2), recurrent aneurysm (2), limb ischemia (1), and limb occlusion (1). Mean follow-up was 4.3 years. Cumulative survival rates at 1 year and 5 years were 82% and 50%, respectively, significantly lower than survival rates for the general population (96% and 81%) and for the noninfected aortic aneurysm cohort (91% and 69%) at same intervals. Rate of survival free of late graft-related complications was 90% at 1 year and 5 years, similar to that reported for patients who had repair of noninfected abdominal aortic aneurysms (97% and 92%). Variables associated with increased risk of aneurysm-related death included extensive periaortic infection, female sex, Staphylococcus aureus infection, aneurysm rupture, and suprarenal aneurysm location (P <.05). For risk of vascular complications, extensive periaortic infection, female sex, leukocytosis, and hemodynamic instability were positively associated (P <.05). CONCLUSION: Infected aortic aneurysms have an aggressive presentation and a complicated early outcome. However, late outcome is surprisingly favorable, with no aneurysm-related deaths and a low graft-related complication rate, similar to standard aneurysm repair. In situ aortic grafting is a safe and durable option in most patients.", "author" : [ { "dropping-particle" : "", "family" : "Oderich", "given" : "G S", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Panneton", "given" : "J M", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Bower", "given" : "T C", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Cherry Jr.", "given" : "K J", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Rowland", "given" : "C M", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Noel", "given" : "A A", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Hallett Jr.", "given" : "J W", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Gloviczki", "given" : "P", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "J Vasc Surg", "id" : "ITEM-2", "issue" : "5", "issued" : { "date-parts" : [ [ "2001" ] ] }, "note" : "Oderich, G S\nPanneton, J M\nBower, T C\nCherry, K J Jr\nRowland, C M\nNoel, A A\nHallett, J W Jr\nGloviczki, P\neng\n2001/11/09 10:00\nJ Vasc Surg. 2001 Nov;34(5):900-8. doi: 10.1067/mva.2001.118084.", "page" : "900-908", "title" : "Infected aortic aneurysms: aggressive presentation, complicated early outcome, but durable results", "type" : "article-journal", "volume" : "34" }, "uris" : [ "http://www.mendeley.com/documents/?uuid=a39bdf48-86c6-451f-8493-75fb56a9a6ea" ] }, { "id" : "ITEM-3", "itemData" : { "DOI" : "10.1161/CIRCULATIONAHA.114.009481", "ISBN" : "1524-4539 (Electronic)\r0009-7322 (Linking)", "PMID" : "25378548", "abstract" : "BACKGROUND: Mycotic aortic aneurysm (MAA) is a rare and life-threatening disease. The aim of this European multicenter collaboration was to study the durability of endovascular aortic repair (EVAR) of MAA, by assessing late infection-related complications and long-term survival. METHODS AND RESULTS: All EVAR treated MAAs, between 1999 and 2013 at 16 European centers, were retrospectively reviewed. One hundred twenty-three patients with 130 MAAs were identified. Mean age was 69 years (range 39-86), 87 (71%) were men, 58 (47%) had immunodeficiency, and 47 (38%) presented with rupture. Anatomic locations were ascending/arch (n=4), descending (n=34), paravisceral (n=15), infrarenal aorta (n=63), and multiple (n=7). Treatments were thoracic EVAR (n=43), fenestrated/branched EVAR (n=9), and infrarenal EVAR (n=71). Antibiotic was administered for mean 30 weeks. Mean follow-up was 35 months (range 1 week to 149 months). Six patients (5%) were converted to open repair during follow-up. Survival was 91% (95% confidence interval, 86% to 96%), 75% (67% to 83%), 55% (44% to 66%), and 41% (28% to 54%) after 1, 12, 60, and 120 months, respectively. Infection-related death occurred in 23 patients (19%), 9 after discontinuation of antibiotic treatment. A Cox regression analysis demonstrated non-Salmonella-positive culture as predictors for late infection-related death. CONCLUSIONS: Endovascular treatment of MAA is feasible and for most patients a durable treatment option. Late infections do occur, are often lethal, and warrant long-term antibiotic treatment and follow-up. Patients with non-Salmonella-positive blood cultures were more likely to die from late infection.", "author" : [ { "dropping-particle" : "", "family" : "Sorelius", "given" : "K", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Mani", "given" : "K", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Bjorck", "given" : "M", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Sedivy", "given" : "P", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Wahlgren", "given" : "C M", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Taylor", "given" : "P", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Clough", "given" : "R E", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Lyons", "given" : "O", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Thompson", "given" : "M", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Brownrigg", "given" : "J", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Ivancev", "given" : "K", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Davis", "given" : "M", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Jenkins", "given" : "M P", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Jaffer", "given" : "U", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Bown", "given" : "M", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Rancic", "given" : "Z", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Mayer", "given" : "D", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Brunkwall", "given" : "J", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Gawenda", "given" : "M", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Kolbel", "given" : "T", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Jean-Baptiste", "given" : "E", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Moll", "given" : "F", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Berger", "given" : "P", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Liapis", "given" : "C D", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Moulakakis", "given" : "K G", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Langenskiold", "given" : "M", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Roos", "given" : "H", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Larzon", "given" : "T", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Pirouzram", "given" : "A", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Wanhainen", "given" : "A", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "European", "given" : "M A A collaborators", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Circulation", "id" : "ITEM-3", "issue" : "24", "issued" : { "date-parts" : [ [ "2014" ] ] }, "note" : "Sorelius, Karl\nMani, Kevin\nBjorck, Martin\nSedivy, Petr\nWahlgren, Carl-Magnus\nTaylor, Peter\nClough, Rachel E\nLyons, Oliver\nThompson, Matt\nBrownrigg, Jack\nIvancev, Krassi\nDavis, Meryl\nJenkins, Michael P\nJaffer, Usman\nBown, Matt\nRancic, Zoran\nMayer, Dieter\nBrunkwall, Jan\nGawenda, Michael\nKolbel, Tilo\nJean-Baptiste, Elixene\nMoll, Frans\nBerger, Paul\nLiapis, Christos D\nMoulakakis, Konstantinos G\nLangenskiold, Marcus\nRoos, Hakan\nLarzon, Thomas\nPirouzram, Artai\nWanhainen, Anders\neng\nG1000327/Medical Research Council/United Kingdom\nMulticenter Study\n2014/11/08 06:00\nCirculation. 2014 Dec 9;130(24):2136-42. doi: 10.1161/CIRCULATIONAHA.114.009481. Epub 2014 Nov 5.", "page" : "2136-2142", "title" : "Endovascular treatment of mycotic aortic aneurysms: a European multicenter study", "type" : "article-journal", "volume" : "130" }, "uris" : [ "http://www.mendeley.com/documents/?uuid=b5cd9fbb-81e9-4a21-9652-2cdd3dee6586" ] } ], "mendeley" : { "formattedCitation" : "111\u2013113", "plainTextFormattedCitation" : "111\u2013113", "previouslyFormattedCitation" : "111\u2013113" }, "properties" : { }, "schema" : "https://github.com/citation-style-language/schema/raw/master/csl-citation.json" }111113 Antibiotic therapy is important pre-and postoperatively, but there are few reports on this as a sole curative treatment.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1016/j.jvs.2008.08.004", "ISBN" : "1097-6809 (Electronic)\r0741-5214 (Linking)", "PMID" : "18848757", "abstract" : "BACKGROUND: Infected aneurysm of the aorta is almost always fatal without undergoing aortic resection. Medical treatment was attempted selectively in patients who were considered too high risk for surgery. We review our experience with 22 patients treated without undergoing aortic resection over 12 years. METHODS: Retrospective chart review. RESULTS: Between 1995 and 2007, 22 cases of infected aortic aneurysms treated without undergoing aortic resection during the first admission were included. There were 17 men with a median age of 76 years (range, 35 to 88 years). Of 18 pathogens isolated, the most common responsible microorganism was nontyphoid Salmonella in 11 followed by Staphylococcus aureus in five. The site of infection was thoracic in eight and abdominal in 14. The hospital mortality rate was 50%, and the aneurysm-related mortality rate after long-term follow-up was 59%. The event-free survival rate at one year was 32%. Of 11 patients with Salmonella infection, eight patients have lived beyond 30 days and six were event-free after one year. Of 11 patients with non-Salmonella, four patients have lived beyond 30 days and only one was event-free after one year. The overall aneurysm-related mortality rate was 36% in Salmonella infected patients and 82% in non-Salmonella infected patients. CONCLUSION: Clinical results of medical treatment using current antibiotics in patients with infected aortic aneurysm were poor. Traditional surgical excision of infected aortic aneurysms with revascularization remains the gold standard and should be attempted except in high risk patients.", "author" : [ { "dropping-particle" : "", "family" : "Hsu", "given" : "R B", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Chang", "given" : "C I", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Wu", "given" : "I H", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Lin", "given" : "F Y", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "J Vasc Surg", "id" : "ITEM-1", "issue" : "1", "issued" : { "date-parts" : [ [ "2009" ] ] }, "note" : "Hsu, Ron-Bin\nChang, Chung-I\nWu, I-Hui\nLin, Fang-Yue\neng\n2008/10/14 09:00\nJ Vasc Surg. 2009 Jan;49(1):66-70. doi: 10.1016/j.jvs.2008.08.004. Epub 2008 Oct 11.", "page" : "66-70", "title" : "Selective medical treatment of infected aneurysms of the aorta in high risk patients", "type" : "article-journal", "volume" : "49" }, "uris" : [ "http://www.mendeley.com/documents/?uuid=8f799f4d-203c-4651-b4dc-bb80be3727e2" ] }, { "id" : "ITEM-2", "itemData" : { "DOI" : "10.1016/j.avsg.2009.08.004", "ISBN" : "1615-5947 (Electronic)\r0890-5096 (Linking)", "PMID" : "19932948", "abstract" : "BACKGROUND: Conventional surgery (CS) for treatment of mycotic aortic aneurysm has rather high surgical morbidity and mortality rates. The use of endovascular aortic repair (EVAR) might simplify the procedure and provide a good alternative for this critical condition, but this remains to be proved. We analyzed all mycotic abdominal aortic aneurysm (AAA) cases treated by CS or EVAR in our institute and the reported cases treated by EVAR from the literature to determine the risk factors for aneurysm-related mortality and morbidity and to clarify the efficacy of the EVAR technique. METHODS AND RESULTS: All relevant literature reports of EVAR management of mycotic AAA and all cases treated in our institute, 41 cases, were included and analyzed. Of the 20 cases treated by EVAR, one had early mortality (1/20, 5%); of the remaining 21 cases that received CS, the early mortality rate was 4.8% (1/21). Patients in the CS group had a higher late mortality rate than those in the EVAR group (45% vs. 10.5%, p<0.05). However, the 24-month actual survival rate and actuarial aneurysm-related event-free rate were 83.9+/-8.6% and 78.3+/-9.7%, respectively, for the EVAR group and did not significantly differ from the CS group (70.4+/-10.2% and 80.1+/-8.9%). The significant predictors for aneurysm-related mortality and morbidity were age, Salmonella species infection, and leukocytosis, and possibly aortoenteric fistula and shock, but not the EVAR or CS procedures themselves. CONCLUSION: Compared with CS, EVAR might be an alternative strategy for managing mycotic AAAs.", "author" : [ { "dropping-particle" : "", "family" : "Kan", "given" : "C D", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Lee", "given" : "H L", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Luo", "given" : "C Y", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Yang", "given" : "Y J", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Ann Vasc Surg", "id" : "ITEM-2", "issue" : "4", "issued" : { "date-parts" : [ [ "2010" ] ] }, "note" : "Kan, Chung-Dann\nLee, Hsin-Ling\nLuo, Chwan-Yau\nYang, Yu-Jen\neng\nComparative Study\nMeta-Analysis\nReview\nNetherlands\n2009/11/26 06:00\nAnn Vasc Surg. 2010 May;24(4):433-40. doi: 10.1016/j.avsg.2009.08.004. Epub 2009 Nov 25.", "page" : "433-440", "title" : "The efficacy of aortic stent grafts in the management of mycotic abdominal aortic aneurysm-institute case management with systemic literature comparison", "type" : "article-journal", "volume" : "24" }, "uris" : [ "http://www.mendeley.com/documents/?uuid=59e249c0-f7cf-4402-94d8-8441d65e5938" ] } ], "mendeley" : { "formattedCitation" : "114,200", "plainTextFormattedCitation" : "114,200", "previouslyFormattedCitation" : "114,200" }, "properties" : { }, "schema" : "https://github.com/citation-style-language/schema/raw/master/csl-citation.json" }114,200 A 6-12-month period of antibiotic therapy is recommended in patients successfully treated with open repair. In one of the largest multicenter series, 132 patients were treated for mycotic AAA during 20 years, with increasing numbers over time and a shift from open repair to EVAR was noted. The 30-day and 1-year survival rates in treated patients were 86% and 79%, respectively.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1161/CIRCULATIONAHA.116.024021", "ISBN" : "1524-4539 (Electronic)\r0009-7322 (Linking)", "PMID" : "27799273", "abstract" : "BACKGROUND: No reliable comparative data exist between open repair (OR) and endovascular aneurysm repair (EVAR) for mycotic abdominal aortic aneurysms (MAAAs). This nationwide study assessed outcomes after OR and EVAR for MAAA in a population-based cohort. METHODS: All patients treated for MAAAs in Sweden between 1994 and 2014 were identified in the Swedish vascular registry. The primary aim was to assess survival after MAAA with OR and EVAR. Secondary aims were analyses of the rate of recurrent infections and reoperations, and time trends in surgical treatment. Survival was analyzed using Kaplan-Meier and log-rank tests. A propensity score-weighted correction for risk factor differences in the 2 groups was performed, including the operation year to account for differences in treatment and outcomes over time. RESULTS: We identified 132 patients (0.6% of all operated abdominal aortic aneurysms in Sweden). Mean age was 70 years (standard deviation, 9.2), and 50 presented with rupture. Survival at 3 months was 86% (95% confidence interval, 80%-92%), at 1 year 79% (72%-86%), and at 5 years 59% (50%-68%). The preferred operative technique shifted from OR to EVAR after 2001 (proportion EVAR 1994-2000 0%, 2001-2007 58%, 2008-2014 60%). Open repair was performed in 62 patients (47%): aortic resection and extra-anatomic bypass (n=7), in situ reconstruction (n=50), and patch plasty (n=3); 2 patients died intraoperatively. EVAR was performed in 70 patients (53%): standard EVAR (n=55), fenestrated/branched EVAR (n=8), and visceral deviation with stent grafting (n=7); no deaths occurred intraoperatively. Survival at 3 months was lower for OR than for EVAR (74% versus 96%, P<0.001), with a similar trend present at 1 year (73% versus 84%, P=0.054). A propensity score-weighted risk-adjusted analysis confirmed the early better survival associated with EVAR. During median follow-up of 36 and 41 months for OR and EVAR, respectively, there was no difference in long-term survival (5 years 60% versus 58%, P=0.771), infection-related complications (18% versus 24%, P=0.439), or reoperation (21% versus 24%, P=0.650). CONCLUSION: This study demonstrates a paradigm shift in treatment of MAAA in Sweden, with EVAR being the preferred treatment modality. EVAR was associated with improved short-term survival in comparison with OR, without higher associated incidence of serious infection-related complications or reoperations.", "author" : [ { "dropping-particle" : "", "family" : "Sorelius", "given" : "K", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Wanhainen", "given" : "A", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Furebring", "given" : "M", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Bjorck", "given" : "M", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Gillgren", "given" : "P", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Mani", "given" : "K", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Swedish Collaborator Group for Mycotic Abdominal Aortic", "given" : "Aneurysms", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Circulation", "id" : "ITEM-1", "issue" : "23", "issued" : { "date-parts" : [ [ "2016" ] ] }, "note" : "Sorelius, Karl\nWanhainen, Anders\nFurebring, Mia\nBjorck, Martin\nGillgren, Peter\nMani, Kevin\neng\n2016/11/02 06:00\nCirculation. 2016 Dec 6;134(23):1822-1832. doi: 10.1161/CIRCULATIONAHA.116.024021. Epub 2016 Oct 31.", "page" : "1822-1832", "title" : "Nationwide Study of the Treatment of Mycotic Abdominal Aortic Aneurysms Comparing Open and Endovascular Repair", "type" : "article-journal", "volume" : "134" }, "uris" : [ "http://www.mendeley.com/documents/?uuid=91f099dc-97ac-44fd-809c-24952589f8df" ] } ], "mendeley" : { "formattedCitation" : "201", "plainTextFormattedCitation" : "201", "previouslyFormattedCitation" : "201" }, "properties" : { }, "schema" : "https://github.com/citation-style-language/schema/raw/master/csl-citation.json" }201
Figure Legends [Au: please see attached powerpoint; the legends will need to match the new/updated figures, please add/edit as necessary]
Figure 1 (new) Abdominal aortic aneurysms
[Au: please provide a legend]
Figure 2. Risk factors for AAAs. Data on 2,217 AAA cases and 66,638 controls reported by Lederle et al. 1997ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "ISBN" : "0003-4819 (Print)\r0003-4819 (Linking)", "PMID" : "9072929", "abstract" : "BACKGROUND: Independent risk factors for abdominal aortic aneurysm (AAA) have not been clearly defined in multivariable analyses of large patient populations. OBJECTIVE: To identify factors that are independently associated with AAA and to determine the prevalence of previously unrecognized AAA in defined demographic and risk groups. DESIGN: Cross-sectional screening study. SETTING: 15 Department of Veterans Affairs medical centers. PARTICIPANTS: 73451 veterans who were 50 to 79 years of age and had no history of AAA. MEASUREMENTS: The results of ultrasonographic screening for AAA and a prescreening questionnaire were analyzed using multiple logistic regression. RESULTS: An AAA of 4.0 cm or larger was detected in 1031 participants (1.4%). Smoking was the risk factor most strongly associated with AAA; the odds ratio (OR) for AAAs of 4.0 cm or larger compared with normal aortas (infrarenal aortic diameter < 3.0 cm) was 5.57 (95% CI, 4.24 to 7.31). The association between smoking and AAA increased significantly with the number of years of smoking and decreased significantly with the number of years after quitting smoking. The excess prevalence associated with smoking accounted for 78% of all AAAs that were 4.0 cm or larger in the study sample. Female sex (OR, 0.22 [CI, 0.07 to 0.68]), black race (OR, 0.49 [CI, 0.35 to 0.69]), and presence of diabetes (OR, 0.54 [CI, 0.44 to 0.65]) were negatively associated with AAA. A family history of AAA was positively associated with AAA (OR, 1.95 [CI, 1.56 to 2.43]) but was reported by only 5.1% of participants. Other independently associated factors included age, height, coronary artery disease, any atherosclerosis, high cholesterol levels, and hypertension. CONCLUSIONS: Abdominal aortic aneurysm is associated with multiple factors. Smoking was the risk factor most strongly associated with AAA and may be responsible for most clinically important cases of previously undiagnosed AAA.", "author" : [ { "dropping-particle" : "", "family" : "Lederle", "given" : "F A", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Johnson", "given" : "G R", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Wilson", "given" : "S E", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Chute", "given" : "E P", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Littooy", "given" : "F N", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Bandyk", "given" : "D", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Krupski", "given" : "W C", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Barone", "given" : "G W", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Acher", "given" : "C W", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Ballard", "given" : "D J", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Ann Intern Med", "edition" : "1997/03/15", "id" : "ITEM-1", "issue" : "6", "issued" : { "date-parts" : [ [ "1997" ] ] }, "language" : "eng", "note" : "Lederle, F A\nJohnson, G R\nWilson, S E\nChute, E P\nLittooy, F N\nBandyk, D\nKrupski, W C\nBarone, G W\nAcher, C W\nBallard, D J\nMulticenter Study\nResearch Support, U.S. Gov't, Non-P.H.S.\nUnited states\nAnnals of internal medicine\nAnn Intern Med. 1997 Mar 15;126(6):441-9.", "page" : "441-449", "title" : "Prevalence and associations of abdominal aortic aneurysm detected through screening. Aneurysm Detection and Management (ADAM) Veterans Affairs Cooperative Study Group", "type" : "article-journal", "volume" : "126" }, "uris" : [ "http://www.mendeley.com/documents/?uuid=e6c35270-7cae-47e8-85dc-1c69acf1e4a3" ] } ], "mendeley" : { "formattedCitation" : "56", "plainTextFormattedCitation" : "56", "previouslyFormattedCitation" : "56" }, "properties" : { }, "schema" : "https://github.com/citation-style-language/schema/raw/master/csl-citation.json" }56 were used to create a plot of the most significant positive and negative risk factors for AAAs [OR (fixed 95% CI)]. Reproduced with permission from Nischan J, Lenk GM, Boddy AM, Lillvis JH, Tromp G, Kuivaniemi H. Abdominal Aortic Aneurysms a Complex Genetic Disease. In: Aneurysms: Types, Risks, Formation and Treatment (ISBN: 978-1-60741-557-2), Nova Science Publishers, Inc., Hauppauge, NY, A Laurent and E Morel, eds., pp. 35-93, 2009.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "author" : [ { "dropping-particle" : "", "family" : "Nischan", "given" : "J", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Lenk", "given" : "G M", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Boddy", "given" : "A M", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Lillvis", "given" : "J H", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Tromp", "given" : "G", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Kuivaniemi", "given" : "H", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Aneurysms: Types, Risks, Formation and Treatment", "edition" : "Nova Biome", "editor" : [ { "dropping-particle" : "", "family" : "Laurent", "given" : "A", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Morel", "given" : "E", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "id" : "ITEM-1", "issued" : { "date-parts" : [ [ "2009" ] ] }, "page" : "35-93", "title" : "Abdominal Aortic Aneurysms-a Complex Genetic Disease", "type" : "chapter" }, "uris" : [ "http://www.mendeley.com/documents/?uuid=2c7b9806-ce60-4bbb-a249-b955780c3985" ] } ], "mendeley" : { "formattedCitation" : "55", "plainTextFormattedCitation" : "55", "previouslyFormattedCitation" : "55" }, "properties" : { }, "schema" : "https://github.com/citation-style-language/schema/raw/master/csl-citation.json" }55
[Au: original figure 2 deleted for brevity]
Figure 3. A speculative model of AAA progression. As in the progression of other forms of atherothrombosis, interactions with various blood components, soluble plasma molecules, and circulating cells can possibly result in an injury in the aortic wall. These interactions promote a formation of an intraluminal thrombus (ILT) which has proteolytic and oxidative activities. These processes facilitate breakdown of the extracellular matrix (ECM), apoptosis of vascular smooth muscle cells (VSMC), and activation of immune responses. ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1160/TH13-08-0721", "ISBN" : "2567-689X (Electronic)\r0340-6245 (Linking)", "PMID" : "24599423", "abstract" : "Iron deposits are observed in tissue of abdominal aortic aneurysm (AAA) patients, although the underlying mechanisms are not completely elucidated. Therefore we explored circulating markers of iron metabolism in AAA patients, and tested if they could serve as biomarkers of AAA. Increased red blood cell (RBC)-borne iron retention and transferrin, transferrin receptor and ferritin expression was observed in AAA tissue compared to control aorta (immunohistochemistry and western blot). In contrast, decreased circulating iron, transferrin, mean corpuscular haemoglobin concentration (MCHC) and haemoglobin concentration, along with circulating RBC count, were observed in AAA patients (aortic diameter >3 cm, n=114) compared to controls (aortic diameter <3 cm, n=88) (ELISA), whereas hepcidin concentrations were increased in AAA subjects (MS/MS assay). Moreover, iron, transferrin and haemoglobin levels were negatively, and hepcidin positively, correlated with aortic diameter in AAA patients. The association of low haemoglobin with AAA presence or aortic diameter was independent of specific risk factors. Moreover, MCHC negatively correlated with thrombus area in another cohort of AAA patients (aortic diameter 3-5 cm, n=357). We found that anaemia was significantly more prevalent in AAA patients (aortic diameter >5 cm, n=8,912) compared to those in patients with atherosclerotic aorto-iliac occlusive disease (n=17,737) [adjusted odds ratio=1.77 (95% confidence interval: 1.61;1.93)]. Finally, the mortality risk among AAA patients with anaemia was increased by almost 30% [adjusted hazard ratio: 1.29 (95% confidence interval: 1.16;1.44)] as compared to AAA subjects without anaemia. In conclusion, local iron retention and altered iron recycling associated to high hepcidin and low transferrin systemic concentrations could lead to reduced circulating haemoglobin levels in AAA patients. Low haemoglobin levels are independently associated to AAA presence and clinical outcome.", "author" : [ { "dropping-particle" : "", "family" : "Martinez-Pinna", "given" : "R", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Lindholt", "given" : "J S", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Madrigal-Matute", "given" : "J", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Blanco-Colio", "given" : "L M", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Esteban-Salan", "given" : "M", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Torres-Fonseca", "given" : "M M", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Lefebvre", "given" : "T", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Delbosc", "given" : "S", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Laustsen", "given" : "J", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Driss", "given" : "F", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Vega de Ceniga", "given" : "M", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Gouya", "given" : "L", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Weiss", "given" : "G", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Egido", "given" : "J", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Meilhac", "given" : "O", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Michel", "given" : "J B", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Martin-Ventura", "given" : "J", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Thromb Haemost", "id" : "ITEM-1", "issue" : "1", "issued" : { "date-parts" : [ [ "2014" ] ] }, "note" : "Martinez-Pinna, R\nLindholt, J S\nMadrigal-Matute, J\nBlanco-Colio, L M\nEsteban-Salan, M\nTorres-Fonseca, M M\nLefebvre, T\nDelbosc, S\nLaustsen, J\nDriss, F\nVega de Ceniga, M\nGouya, L\nWeiss, G\nEgido, J\nMeilhac, O\nMichel, J-B\nMartin-Ventura, J\neng\nGermany\n2014/03/07 06:00\nThromb Haemost. 2014 Jul 3;112(1):87-95. doi: 10.1160/TH13-08-0721. Epub 2014 Mar 6.", "page" : "87-95", "title" : "From tissue iron retention to low systemic haemoglobin levels, new pathophysiological biomarkers of human abdominal aortic aneurysm", "type" : "article-journal", "volume" : "112" }, "uris" : [ "http://www.mendeley.com/documents/?uuid=bd93b3e9-8094-47ca-b17a-1996b8767b8f" ] } ], "mendeley" : { "formattedCitation" : "90", "plainTextFormattedCitation" : "90", "previouslyFormattedCitation" : "90" }, "properties" : { }, "schema" : "https://github.com/citation-style-language/schema/raw/master/csl-citation.json" }90
Figure 4 (new): Role of ECM and immune system in AAA pathogenesis
[Au: please see attached powerpoint]
Figure 5 (new): Conventional imaging of AAA
[Au: please see attached powerpoint] 1: Done
A:Sagital section of an infrarenal aortic aneurysm in male patient (yellow arrows) with parital thrombus (Asterix)
B:CT images of abdominal aortic aneurysms in same patient with parital thrombus (asterix)
C:2D T1-weight post contrast MRI in the same patient
Figure 6. Functional imaging of AAA
[Au: please see powerpoint] (Done)
A:Coronal section showing increased 18F-FDG uptake in the abdomen of male patient with painfull aneurysm (Arrow)
B: Fused PET and CT Imaging shows increased uptake in the wall of an abdominal aortic aneurysm (Arrow)
C:Sagital section of PET-CT confirms increasing 18F-FDG FDG uptake at the anterior wall of AAA.
Figure 7. Finite element analysis (FEA) of ruptured (left) and unruptured (right) AAA. FEA was performed for a 60-mm ruptured AAA (left) with a peak wall rupture index [Au: what does this indicate?] (PWRI) of 0.631, and a-60 mm unruptured, asymtomatic AAA with a PWRI of 0.206.
Figure 8. Proposed management of an asymptomatic AAA. This figure summarizes a proposed protocol for patients under surveillance with an asymptomatic AAA. Modified with permission from Sakalihasan et al, Lancet 365, 1577-1589 (2005).46
Figure 9. History of the treatment of AAA.
This figure describes the development and evolution of the treatment of AAA, including the current front-line endovascular techniques. [Au: text in green moved from Surgical management section] The modern history of the treatment of AAAs started on the 29th March 1951, when Charles Dubost successfully carried out the resection of an AAA followed by the implantation of a homograft in place of the AAA (FIG. 8).ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "ISBN" : "0096-6908 (Print)\r0096-6908 (Linking)", "PMID" : "14894065", "author" : [ { "dropping-particle" : "", "family" : "Dubost", "given" : "C", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Allary", "given" : "M", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Oeconomos", "given" : "N", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "AMA Arch Surg", "id" : "ITEM-1", "issue" : "3", "issued" : { "date-parts" : [ [ "1952" ] ] }, "note" : "DUBOST, C\nALLARY, M\nOECONOMOS, N\neng\n1952/03/01 00:00\nAMA Arch Surg. 1952 Mar;64(3):405-8.", "page" : "405-408", "title" : "Resection of an aneurysm of the abdominal aorta: reestablishment of the continuity by a preserved human arterial graft, with result after five months", "type" : "article-journal", "volume" : "64" }, "uris" : [ "http://www.mendeley.com/documents/?uuid=5500c4f0-0f73-4064-9d29-808d2b9e1de2" ] } ], "mendeley" : { "formattedCitation" : "160", "plainTextFormattedCitation" : "160", "previouslyFormattedCitation" : "160" }, "properties" : { }, "schema" : "https://github.com/citation-style-language/schema/raw/master/csl-citation.json" }160 Less than one month earlier, Schaffer & HardingADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "ISBN" : "0039-6060 (Print)\r0039-6060 (Linking)", "PMID" : "14913427", "author" : [ { "dropping-particle" : "", "family" : "Schafer", "given" : "P W", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Hardin", "given" : "C A", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Surgery", "id" : "ITEM-1", "issue" : "2", "issued" : { "date-parts" : [ [ "1952" ] ] }, "note" : "SCHAFER, P W\nHARDIN, C A\neng\n1952/02/01 00:00\nSurgery. 1952 Feb;31(2):186-99.", "page" : "186-199", "title" : "The use of temporary polythene shunts to permit occlusion, resection, and frozen homologus graft replacement of vital vessel segments; a laboratory and clinical study", "type" : "article-journal", "volume" : "31" }, "uris" : [ "http://www.mendeley.com/documents/?uuid=1c1f51eb-2475-4f0e-8ebd-8c460a702609" ] } ], "mendeley" : { "formattedCitation" : "161", "plainTextFormattedCitation" : "161", "previouslyFormattedCitation" : "161" }, "properties" : { }, "schema" : "https://github.com/citation-style-language/schema/raw/master/csl-citation.json" }161 had carried out the same intervention, but their patient had died on the 29th day following the operation. Shortly after, De Bakey popularized the operation by using a textile graft to replace the aneurysmal section of the aorta.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "ISSN" : "0039-6087", "PMID" : "13090050", "author" : [ { "dropping-particle" : "", "family" : "BAKEY", "given" : "M E", "non-dropping-particle" : "DE", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "COOLEY", "given" : "D A", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Surgery, gynecology & obstetrics", "id" : "ITEM-1", "issue" : "3", "issued" : { "date-parts" : [ [ "1953", "9" ] ] }, "page" : "257-66", "title" : "Surgical treatment of aneurysm of abdominal aorta by resection and restoration of continuity with homograft.", "type" : "article-journal", "volume" : "97" }, "uris" : [ "http://www.mendeley.com/documents/?uuid=f7e2ab79-cca1-3301-a2b3-da0dde93f0fe" ] } ], "mendeley" : { "formattedCitation" : "162", "plainTextFormattedCitation" : "162", "previouslyFormattedCitation" : "162" }, "properties" : { }, "schema" : "https://github.com/citation-style-language/schema/raw/master/csl-citation.json" }162 In 1966, Creech proposed to leave the aneurysmal sac open in place (rather than excise) and to place the graft inside the sac to make the proximal termino-terminal suture on the stump.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "ISBN" : "0003-4932 (Print)\r0003-4932 (Linking)", "PMID" : "5332747", "author" : [ { "dropping-particle" : "", "family" : "Creech Jr.", "given" : "O", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Ann Surg", "id" : "ITEM-1", "issue" : "6", "issued" : { "date-parts" : [ [ "1966" ] ] }, "note" : "Creech, O Jr\neng\n1966/12/01 00:00\nAnn Surg. 1966 Dec;164(6):935-46.", "page" : "935-946", "title" : "Endo-aneurysmorrhaphy and treatment of aortic aneurysm", "type" : "article-journal", "volume" : "164" }, "uris" : [ "http://www.mendeley.com/documents/?uuid=4bab5397-2804-4c63-a593-64ad3fb1c3db" ] } ], "mendeley" : { "formattedCitation" : "163", "plainTextFormattedCitation" : "163", "previouslyFormattedCitation" : "163" }, "properties" : { }, "schema" : "https://github.com/citation-style-language/schema/raw/master/csl-citation.json" }163 EVAR was first performed in 1987 by Volodos et al.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1583/1545-1550-20.sp1.I-3", "ISBN" : "1545-1550 (Electronic)\r1526-6028 (Linking)", "PMID" : "23448181", "author" : [ { "dropping-particle" : "", "family" : "Volodos", "given" : "N L", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "J Endovasc Ther", "id" : "ITEM-1", "issued" : { "date-parts" : [ [ "2013" ] ] }, "note" : "Volodos, Nikolay L\neng\nBiography\nHistorical Article\n2013/03/02 06:00\nJ Endovasc Ther. 2013 Winter-Spring;20 Suppl 1:I3-23. doi: 10.1583/1545-1550-20.sp1.I-3.", "page" : "I3-23", "title" : "Historical perspective: The first steps in endovascular aortic repair: how it all began", "type" : "article-journal", "volume" : "20 Suppl 1" }, "uris" : [ "http://www.mendeley.com/documents/?uuid=112901c8-4f75-4301-997a-fd4b0a61cbfd" ] } ], "mendeley" : { "formattedCitation" : "164", "plainTextFormattedCitation" : "164", "previouslyFormattedCitation" : "164" }, "properties" : { }, "schema" : "https://github.com/citation-style-language/schema/raw/master/csl-citation.json" }164 for the treatment of a post-traumatic thoracic aortic aneurysm (FIG. 8). In 1991 Parodi et al.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "ISBN" : "0890-5096 (Print) 0890-5096 (Linking)", "PMID" : "1837729", "abstract" : "This study reports on animal experimentation and initial clinical trials exploring the feasibility of exclusion of an abdominal aortic aneurysm by placement of an intraluminal, stent-anchored, Dacron prosthetic graft using retrograde cannulation of the common femoral artery under local or regional anesthesia. Experiments showed that when a balloon-expandable stent was sutured to the partially overlapping ends of a tubular, knitted Dacron graft, friction seals were created which fixed the ends of the graft to the vessel wall. This excludes the aneurysm from circulation and allows normal flow through the graft lumen. Initial treatment in five patients with serious co-morbidities is described. Each patient had an individually tailored balloon diameter and diameter and length of their Dacron graft. Standard stents were used and the diameter of the stent-graft was determined by sonography, computed tomography, and arteriography. In three of them a cephalic stent was used without a distal stent. In two other patients both ends of the Dacron tubular stent were attached to stents using a one-third stent overlap. In these latter two, once the proximal neck of the aneurysm was reached, the sheath was withdrawn and the cephalic balloon inflated with a saline/contrast solution. The catheter was gently removed caudally towards the arterial entry site in the groin to keep tension on the graft, and the second balloon inflated so as to deploy the second stent. Four of the five patients had heparin reversal at the end of the procedure. We are encouraged by this early experience, but believe that further developments and more clinical trials are needed before this technique becomes widely used.", "author" : [ { "dropping-particle" : "", "family" : "Parodi", "given" : "J C", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Palmaz", "given" : "J C", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Barone", "given" : "H D", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Ann Vasc Surg", "edition" : "1991/11/01", "id" : "ITEM-1", "issue" : "6", "issued" : { "date-parts" : [ [ "1991" ] ] }, "language" : "eng", "note" : "Parodi, J C\nPalmaz, J C\nBarone, H D\nCase Reports\nUnited states\nAnnals of vascular surgery\nAnn Vasc Surg. 1991 Nov;5(6):491-9.", "page" : "491-499", "title" : "Transfemoral intraluminal graft implantation for abdominal aortic aneurysms", "type" : "article-journal", "volume" : "5" }, "uris" : [ "http://www.mendeley.com/documents/?uuid=c4aa158f-99aa-4f6a-b9c8-d17af7d8ca77" ] } ], "mendeley" : { "formattedCitation" : "165", "plainTextFormattedCitation" : "165", "previouslyFormattedCitation" : "165" }, "properties" : { }, "schema" : "https://github.com/citation-style-language/schema/raw/master/csl-citation.json" }165 reported their initial experience with the use of stent-grafts to treat AAA. [Au: please briefly explain the procedures mentioned below]
1817: Astley Cooper, Ligation of Aorta
1903, Rudolph Matassugery based on arteriorhraphy;
1921, Darcy Power, Palliative treatment by wiring with the Colts apparatus;
1951, The use of temporary polythene shunts to permit occlusion, resection and frozen homologous graft replacement (of vital vessel segments)
1989, Transfemoral intraluminal graft transplantation for AAA; EVAR
Figure 10: Endovascular AAA repair. An AAA was treated by a stent-graft.
Figure 11. Surgical treatment of AAA. Use of a tube graft (A), a Y-graft from the aorta to both common iliac arteries (B), and a Y-graft with common femoral arteries (C), is demonstrated. The inferior mesenteric artery can be reimplanted into the textile graft using tailoring of a Carrel patch (D). [Au: please provide the source of these images]
Table 1. Single nucleotide polymorphisms associated with AAA. [Au: P value column deleted for brevity, as it is already stated in the footnote that all these SNPs have significant association]
SNPChr.Nearest gene(s)Protein[Au: please insert here the proteins encoded by the genes, rather than listing them as footnotes. Can we also include the function of each protein (if known)?]MAFOR95%CIrs6026331PSRC1-CELSR2-SORT10.2000.8790.8420.918rs41292671IL6R0.3700.8760.8460.908rs17950611SMYD20.3331.1311.0901.174rs107572749CDKN2BAS10.4570.8060.7780.834rs109853499DAB2IP0.1931.1711.1181.226rs931687113LINC005400.2040.8730.8370.911rs651172019LDLR0.0970.8040.7590.851rs382706620PCIF1-ZNF335-MMP90.1841.2231.1681.281rs283641121ERG0.3671.1131.0741.154
SNP, single nucleotide polymorphism; Chr., chromosome; MAF, minor allele frequency; [Au: what does this parameter indicate?] OR, odds ratio; 95%CI, 95% confidence interval for the OR; PSRC1, proline and serine rich coiled-coil 1; CELSR2; cadherin, EGF LAG seven-pass G-type receptor 2; SORT1, sortilin 1; IL6R, interleukin 6 receptor; CDKN2BAS1, CDKN2B antisense RNA 1, also known as ANRIL; DAB2IP, DAB2 interacting protein; LDLR, low density lipoprotein receptor; SMYD2, SET and MYND domain containing 2 (SET domain-containing proteins, such as SMYD2, catalyze lysine methylation); LINC00540, long intergenic non-protein coding RNA 540; PCIF1, C-terminal inhibiting factor 1 of a protein called pancreatic and duodenal homeobox 1; ZNF335, zinc finger protein 335; MMP9, matrix metalloproteinase 9; ERG, v-ets avian erythroblastosis virus E26 oncogene homolog. The discovery phase of the meta-GWAS was carried out with 4,972 AAA cases and 99,858 controls. Independent validation cohorts included 5,232 AAA cases and 7,908 controls. The table summarizes the genome-wide significant (P<5x10-8) and validated associations. For details, see Jones et al. 2017.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1161/CIRCRESAHA.116.308765", "ISSN" : "15244571", "abstract" : "\u00a9 2016 The Authors. Rationale: Abdominal aortic aneurysm (AAA) is a complex disease with both genetic and environmental risk factors. Together, 6 previously identified risk loci only explain a small proportion of the heritability of AAA. Objective: To identify additional AAA risk loci using data from all available genome-wide association studies. Methods and Results: Through a meta-analysis of 6 genome-wide association study data sets and a validation study totaling 10 204 cases and 107 766 controls, we identified 4 new AAA risk loci: 1q32.3 (SMYD2), 13q12.11 (LINC00540), 20q13.12 (near PCIF1/MMP9/ZNF335), and 21q22.2 (ERG). In various database searches, we observed no new associations between the lead AAA single nucleotide polymorphisms and coronary artery disease, blood pressure, lipids, or diabetes mellitus. Network analyses identified ERG, IL6R, and LDLR as modifiers of MMP9, with a direct interaction between ERG and MMP9. 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Table 2 Complications of surgical and endovascular treatment of AAA [Au: title OK? Title cha n g e d ]
C o m p l i c a t i o n I n c i d e n c e ( % ) D e s c r i p t i o n T r e a t m e n t E V A R A c c e s s s i t e p r o b l e m s 9 "1 5 [ A u : P l e a s e r e f e r e n c e t h i s d a t a . ] . F e e z o r R J , H u b e r T S , M a r t i n T D , e t a l . P e r i o p e r a t i v e d i f f e r e n c e s b e t w e e n e n d o v a s c u l a r r e p a i r o f t h o r a c i c a n d a b d o m i n a l a o r t i c d i s e a ses. J Vasc Surg 2007; 45:86.
Blankensteijn JD, de Jong SE, Prinssen M, et al. Two-year outcomes after conventional or endovascular repair of abdominal aortic aneurysms. N Engl J Med 2005; 352:2398Problems include hematoma, arterial thrombosis, distal embolization, pseudoaneurysm and arteriovenous fistulaSurgical revision [Au: do you mean that an additional surgery is required to fix the complication? Yes type of surgery depends on the complication]Endoleak 2 0 "5 0 ( r e f A D D I N C S L _ C I T A T I O N { " c i t a t i o n I t e m s " : [ { " i d " : " I T E M - 1 " , " i t e m D a t a " : { " I S B N " : " 1 8 2 7 - 1 9 1 X ( E l e c t r o n i c ) \ r 0 0 2 1 - 9 5 0 9 ( L i n k i n g ) " , " P M I D " : " 2 2 4 3 3 7 2 8 " , " a b s t r a c t " : " E n d o l e a k s a r e o n e o f t h e m o s t c o m m o n r e a s o n s f o r r e i n t e r v e n t i o n s a n d f a i l u r e a fter endovascular aneurysm repair (EVAR). Current classifications divide endoleaks into type I-V but a more pragmatic definition is of direct and indirect endoleaks. Direct endoleaks (type I and III) transmit direct systemic pressure to the aneurysm sac and carry a high risk of aneurysm growth and rupture if left untreated. Immediate intervention is generally warranted. Indirect endoleaks (type II, IV, V) may have a more benign course and should be treated only under the presence of aneurysm growth. Appropriate procedural planning and device selection is critical to avoid endoleaks and most direct endoleaks can be identified and treated periprocedurally by use of high quality intraoperative imaging techniques. Late endoleaks can be treated predominately by endovascular means and the need for conversion to open surgery is rare.", "author" : [ { "dropping-particle" : "", "family" : "Resch", "given" : "T", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Dias", "given" : "N", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "J Cardiovasc Surg (Torino)", "id" : "ITEM-1", "issue" : "1 Suppl 1", "issued" : { "date-parts" : [ [ "2012" ] ] }, "note" : "Resch, T\nDias, N\neng\nReview\nItaly\n2012/03/28 06:00\nJ Cardiovasc Surg (Torino). 2012 Feb;53(1 Suppl 1):91-9.", "page" : "91-99", "title" : "Treatment of endoleaks: techniques and outcome", "type" : "article-journal", "volume" : "53" }, "uris" : [ "http://www.mendeley.com/documents/?uuid=93bb81c7-13cd-4e7a-b488-f02a9fd61dba" ] } ], "mendeley" : { "formattedCitation" : "209", "plainTextFormattedCitation" : "209", "previouslyFormattedCitation" : "209" }, "properties" : { }, "schema" : "https://github.com/citation-style-language/schema/raw/master/csl-citation.json" }209) [Au: any data on the incidence of the individual types? ]
Type I: up to 10%
Type II: 10-25% (Nature and significance of endoleaks and endotension: summary of opinions expressed at an international conference.
Veith FJ, Baum RA, Ohki T, et al J Vasc Surg. 2002 May;35(5):1029-35
Type III: up to 4% (Update: Complications and management of infrarenal EVAR. Liaw JV, Clark M, Gibbs R, Jenkins M, Cheshire N, Hamady M. Eur J Radiol. 2009 Sep;71(3):541-51.
Type IV: Very rare with the new generation devices
Persistent blood flow in the aneurysm sac after deployment of the stent-graft.
Type I: insufficient sealing at proximal (type Ia) or distal (type Ib) attachment sites of the stent-graftImplantation of additional stent-grafts more proximally (for Ia) or distally (for Ib). ). In cases of limited landing zone, advanced endovascular techniques (fenestrated and branched stent-grafts) can be used to manage type I endoleaks.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1016/j.ejvs.2013.03.028", "ISBN" : "1532-2165 (Electronic)\r1078-5884 (Linking)", "PMID" : "23642523", "abstract" : "OBJECTIVES: To review our experience with fenestrated endovascular aneurysm repair (F-EVAR) to treat complications after previous standard infrarenal endovascular aneurysm repair (EVAR). METHODS: A prospectively maintained database including all consecutive patients with juxtarenal abdominal aortic aneurysm that were treated with F-EVAR after failed previous EVAR within the period March 2002 to November 2012 at the University Medical Center of Groningen, Netherlands (up to October 2009), and the Klinikum Nurnberg Sud, Germany (from November 2009) was analyzed. Evaluated outcomes included initial technical success, operative mortality and morbidity, and late procedure-related events with regard to survival, target vessel patency, endoleak, renal function, and reintervention. RESULTS: A total of 26 patients (24 male, mean age 73.2 +/- 6.5 years) were treated. All patients had proximal anatomies precluding endovascular reintervention with standard techniques. In 23 patients a fenestrated proximal cuff was used, and in three patients a bifurcated fenestrated stent graft. Technical success was achieved in 24 (92.3%) patients. One patient required on-table open conversion because of impossibility to retrieve the top cap as a result of twist of the ipsilateral limb. In the second patient the right kidney was lost due to inadvertent stenting in a smaller branch of the renal artery. Catheterization difficulties, all related to the passage through the limbs or struts of the previous stent graft, were encountered in 11 (42.3%) cases, including five (19.2%) patients with iliac access problems and six (23.1%) with challenging renal catheterization. Operative target vessel perfusion success rate was 94.6% (70/74). Operative mortality was 0%. Mean follow-up was 26.8 +/- 28.5 months. No proximal type I endoleak was present on first postoperative CTA. The mean aneurysm maximal diameter decreased from 73 +/- 20 mm to 66.7 +/- 21 mm (p < .05). There were six late deaths, one of them aneurysm related. Estimated survival rates at 1 and 2 years were 94.1 +/- 5.7% and 87.4 +/- 8.4%, respectively. Patency during follow-up for the target vessels treated successfully with a fenestrated stent graft was 100% (70/70). Reintervention was required in four cases, including one acute conversion due to rupture, one for iliac limb occlusion and two for type Ib and II endoleak. Renal function deterioration was observed solely in the two cases of primary technical failure. CONCLUSIONS: F-E\u2026", "author" : [ { "dropping-particle" : "", "family" : "Katsargyris", "given" : "A", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Yazar", "given" : "O", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Oikonomou", "given" : "K", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Bekkema", "given" : "F", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Tielliu", "given" : "I", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Verhoeven", "given" : "E L", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Eur J Vasc Endovasc Surg", "id" : "ITEM-1", "issue" : "1", "issued" : { "date-parts" : [ [ "2013" ] ] }, "note" : "Katsargyris, A\nYazar, O\nOikonomou, K\nBekkema, F\nTielliu, I\nVerhoeven, E L G\neng\nEngland\n2013/05/07 06:00\nEur J Vasc Endovasc Surg. 2013 Jul;46(1):49-56. doi: 10.1016/j.ejvs.2013.03.028. Epub 2013 May 1.", "page" : "49-56", "title" : "Fenestrated stent-grafts for salvage of prior endovascular abdominal aortic aneurysm repair", "type" : "article-journal", "volume" : "46" }, "uris" : [ "http://www.mendeley.com/documents/?uuid=53333055-f169-42b5-a38d-8c5d01202f24" ] }, { "id" : "ITEM-2", "itemData" : { "DOI" : "10.1016/j.jvs.2006.07.047", "ISBN" : "0741-5214 (Print)\r0741-5214 (Linking)", "PMID" : "17145439", "abstract" : "Three patients with type I proximal endoleak after previous endovascular abdominal aortic aneurysm (AAA) repair were treated with fenestrated endovascular stent grafts. Six renal arteries, three superior mesenteric arteries, and one coeliac axis were targeted for incorporation by graft fenestration. The fenestration-renal ostium interface was secured with balloon-expandable stents and completion angiography demonstrated no endoleaks and antegrade perfusion in all target vessels. All patients made an uncomplicated recovery. Fenestrated endovascular stent grafts can be used to salvage failed prior endovascular AAA repair in patients who are considered unsuitable for other endovascular or open surgical interventions.", "author" : [ { "dropping-particle" : "", "family" : "Adam", "given" : "D J", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Fitridge", "given" : "R A", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Berce", "given" : "M", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Hartley", "given" : "D E", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Anderson", "given" : "J L", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "J Vasc Surg", "id" : "ITEM-2", "issue" : "6", "issued" : { "date-parts" : [ [ "2006" ] ] }, "note" : "Adam, Donald J\nFitridge, Robert A\nBerce, Michael\nHartley, David E\nAnderson, John L\neng\nCase Reports\n2006/12/06 09:00\nJ Vasc Surg. 2006 Dec;44(6):1341-4. doi: 10.1016/j.jvs.2006.07.047.", "page" : "1341-1344", "title" : "Salvage of failed prior endovascular abdominal aortic aneurysm repair with fenestrated endovascular stent grafts", "type" : "article-journal", "volume" : "44" }, "uris" : [ "http://www.mendeley.com/documents/?uuid=19f5a9af-55ea-4b72-9aa0-8a95d7bb1bc5" ] } ], "mendeley" : { "formattedCitation" : "210,211", "plainTextFormattedCitation" : "210,211", "previouslyFormattedCitation" : "210,211" }, "properties" : { }, "schema" : "https://github.com/citation-style-language/schema/raw/master/csl-citation.json" }210,211Type II: backflow via lumbar arteriesType II endoleaks can be treated conservatively, [Au:what does this mean? No intervention, surveillance] but in the case of significant aneurysm sac expansion during follow-up, embolisation of the feeding vessels should be considered.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1016/j.jvs.2017.08.056", "ISBN" : "1097-6809 (Electronic)\r0741-5214 (Linking)", "PMID" : "29042075", "abstract" : "OBJECTIVE: The objective of this study was to delineate the specific types of waveforms that exist in type II endoleaks (T2ELs) and their effect on aneurysm sac size. METHODS: Patients who underwent an endovascular aneurysm repair and were diagnosed with a T2EL were included in the study. The flow velocity characteristics of the T2ELs were evaluated in detail with duplex ultrasound. Four different flow patterns were identified: high resistance, low flow; low resistance, low flow; low resistance, high flow; and to-fro flow. The type and number of vessels involved, time at detection, evolution, and need for treatment were recorded. The aneurysm sac diameter was monitored with duplex ultrasound. A computed tomography scan was always performed at baseline within 1 month of the procedure and repeated only when symptoms developed or there were changes in the ultrasound examination findings, such as sac enlargement. RESULTS: Of 382 patients who underwent endovascular aneurysm repair in our institution, 56 (14.65%) were found to have a T2EL. There were 52 male and four female patients with a mean age of 74 years (61-86 years). The T2EL was diagnosed within the first month in 32 patients; 9 patients were diagnosed at 3 months, 5 patients at 6 months, 3 patients at 9 months, and 7 patients at 1 year or later. There were 43 patients who had a T2EL involving one vessel; two vessels were involved in 11 patients and three vessels were involved in two patients. During follow-up, several changes were observed for the different types of T2EL. High-resistance, low-flow endoleak was detected in 14 patients; of those, 13 were occluded and 1 converted to high flow. Low-resistance, low-flow endoleak was detected in seven patients; of those, five were occluded, one remained stable, and one converted to high flow with sac enlargement requiring treatment. Low-resistance, high-flow endoleak was found in 13 patients; of those, 8 were occluded, 3 remained stable, and 2 had sac enlargement requiring treatment; 1 patient presented with rupture. Finally, to-fro flow was identified in the majority of the patients (22); of those, 14 occluded, 3 remained stable, and 5 had sac enlargement requiring treatment; 2 patients presented with rupture. No deaths due to T2EL were encountered. CONCLUSIONS: Most of the T2ELs resulted in spontaneous occlusion and were not associated with sac enlargement. A low-resistance, high-flow or to-fro flow T2EL has higher chances of sac enlargement, rupture, a\u2026", "author" : [ { "dropping-particle" : "", "family" : "Monastiriotis", "given" : "S", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Lau", "given" : "I", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Loh", "given" : "S", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Ferretti", "given" : "J", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Tassiopoulos", "given" : "A", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Labropoulos", "given" : "N", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "J Vasc Surg", "id" : "ITEM-1", "issued" : { "date-parts" : [ [ "2017" ] ] }, "note" : "Monastiriotis, Spyridon\nLau, Ignatius\nLoh, Shang\nFerretti, John\nTassiopoulos, Apostolos\nLabropoulos, Nicos\neng\n2017/10/19 06:00\nJ Vasc Surg. 2017 Oct 14. pii: S0741-5214(17)32100-6. doi: 10.1016/j.jvs.2017.08.056.", "title" : "Evolution of type II endoleaks based on different ultrasound-identified patterns", "type" : "article-journal" }, "uris" : [ "http://www.mendeley.com/documents/?uuid=a921fb48-5c54-4684-882d-56576552ed11" ] }, { "id" : "ITEM-2", "itemData" : { "DOI" : "10.1016/j.jvs.2017.05.124", "ISBN" : "1097-6809 (Electronic)\r0741-5214 (Linking)", "PMID" : "29389419", "abstract" : "OBJECTIVE: Type II endoleaks (T2ELs) are commonly observed after endovascular aneurysm repair (EVAR). We sought to determine whether time at onset of T2ELs correlated with the need to intervene based on sac expansion or rupture. METHODS: Between 1998 and 2015, 462 EVARs performed at our institution had duplex ultrasound surveillance in our accredited noninvasive vascular laboratory. Computed tomography and arteriography were reserved for abnormal duplex ultrasound findings. The need for intervention for T2ELs was classified according to time at onset after EVAR. Interventions for T2ELs were performed only for sac expansion >5 mm or rupture. We defined early-onset T2ELs as <1 year after EVAR and delayed or late onset as >1 year of follow-up. RESULTS: Of the 462 EVARs, 96 patients (21%) developed T2ELs after implantation. Of these, 65 (68%) had early and 31 (32%) had late onset (mean, 12 months; range, 1-112 months). Early T2ELs resolved without treatment in 75% (49/65) of cases compared with only 29% (9/31) of late T2ELs (P < .0001). Intervention was required for only 8% (5/65) of patients with early T2ELs (5 sac expansions, 0 ruptures) compared with 55% (17/31) for late T2ELs (16 sac expansions, 1 rupture; P < .0001). The remaining patients were observed for persistent T2ELs with no sac growth (17% [11/65] early vs 16% [5/31] late; P = .922). CONCLUSIONS: Less than one-third (29%) of T2ELs that develop after 1 year will resolve spontaneously and about half (55%) will require intervention for sac growth or rupture. T2ELs that develop >1 year after EVAR should be followed up with a more frequent surveillance protocol and perhaps with a lower threshold to intervene.", "author" : [ { "dropping-particle" : "", "family" : "Pineda", "given" : "D M", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Calligaro", "given" : "K D", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Tyagi", "given" : "S", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Troutman", "given" : "D A", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Dougherty", "given" : "M J", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "J Vasc Surg", "id" : "ITEM-2", "issue" : "2", "issued" : { "date-parts" : [ [ "2018" ] ] }, "note" : "Pineda, Danielle M\nCalligaro, Keith D\nTyagi, Sam\nTroutman, Douglas A\nDougherty, Matthew J\neng\n2018/02/02 06:00\nJ Vasc Surg. 2018 Feb;67(2):449-452. doi: 10.1016/j.jvs.2017.05.124.", "page" : "449-452", "title" : "Late type II endoleaks after endovascular aneurysm repair require intervention more frequently than early type II endoleaks", "type" : "article-journal", "volume" : "67" }, "uris" : [ "http://www.mendeley.com/documents/?uuid=88ff1f3c-6356-46ce-aa89-bb0a1b84686e" ] } ], "mendeley" : { "formattedCitation" : "212,213", "plainTextFormattedCitation" : "212,213", "previouslyFormattedCitation" : "212,213" }, "properties" : { }, "schema" : "https://github.com/citation-style-language/schema/raw/master/csl-citation.json" }212,213Type III: separation of stent-graft components
Type IV: results from porosity in the graft meterialManagement includes the use of a bridging stent-graft.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1016/j.jvs.2017.01.056", "ISBN" : "1097-6809 (Electronic)\r0741-5214 (Linking)", "PMID" : "28434700", "abstract" : "OBJECTIVE: The objective of this study was to retrospectively assess the incidence, etiology, and management of type III endoleaks in a large cohort of patients treated with endovascular aneurysm repair (EVAR) in two European university centers. METHODS: From 1995 until 2014, 965 EVAR procedures were performed with use of first- and second-generation (n = 79) or third-generation (n = 886) endografts. Radiologic follow-up was performed with computed tomography and abdominal plain film examinations in accordance with the European Collaborators on Stent/graft Techniques for aortic Aneurysm Repair (EUROSTAR) scheme. The potential relationship between the type of endograft and the incidence of type III endoleak and the time interval between initial EVAR and diagnosis of type III endoleak were calculated. RESULTS: Twenty patients (2.1%) were identified with 25 type III endoleaks (n = 10/79 [12.7%] for first- and second-generation endografts and n = 10/886 [1.2%] for third-generation endografts; P < .001). Disconnection was found in 14 of 25 endoleaks (56%) and a fabric defect in 11 of 25 (44%) endoleaks, both without any difference between first- and second- vs third-generation endografts (P = .216). The time interval between initial EVAR and type III endoleak was 3.87 and 5.92 years, respectively, for first- or second-generation and third-generation endografts (P = .148). Twenty-five type III endoleaks were treated using endovascular techniques (n = 22 [88%]) or by open surgical conversion (n = 3 [12%]). CONCLUSIONS: Type III endoleak rarely (2.1%) occurs after EVAR, with a higher incidence in first- and second-generation endografts. In the majority of cases, the underlying mechanism is disconnection of the stent graft components. Type III endoleaks may occur early or late after initial EVAR and can, in most cases, be managed endovascularly, although type III endoleak may recur.", "author" : [ { "dropping-particle" : "", "family" : "Maleux", "given" : "G", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Poorteman", "given" : "L", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Laenen", "given" : "A", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Saint-Lebes", "given" : "B", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Houthoofd", "given" : "S", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Fourneau", "given" : "I", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Rousseau", "given" : "H", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "J Vasc Surg", "id" : "ITEM-1", "issue" : "4", "issued" : { "date-parts" : [ [ "2017" ] ] }, "note" : "Maleux, Geert\nPoorteman, Lien\nLaenen, Annouschka\nSaint-Lebes, Bertrand\nHouthoofd, Sabrina\nFourneau, Inge\nRousseau, Herve\neng\nMulticenter Study\n2017/04/25 06:00\nJ Vasc Surg. 2017 Oct;66(4):1056-1064. doi: 10.1016/j.jvs.2017.01.056. Epub 2017 Apr 20.", "page" : "1056-1064", "title" : "Incidence, etiology, and management of type III endoleak after endovascular aortic repair", "type" : "article-journal", "volume" : "66" }, "uris" : [ "http://www.mendeley.com/documents/?uuid=459aac0d-24d2-4e6a-b785-959b26e4aa5a" ] } ], "mendeley" : { "formattedCitation" : "214", "plainTextFormattedCitation" : "214", "previouslyFormattedCitation" : "214" }, "properties" : { }, "schema" : "https://github.com/citation-style-language/schema/raw/master/csl-citation.json" }214 If endovascular techniques fail, open surgery is required to definitely treat endoleaks.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1007/s00270-014-0909-y", "ISBN" : "1432-086X (Electronic)\r0174-1551 (Linking)", "PMID" : "24870699", "abstract" : "PURPOSE: To investigate the causes and results of late open surgical conversion (LOSC) after failed abdominal aortic aneurysm repair (EVAR) and to summarize our 17 years' experience with 13 various endografts. METHODS: Retrospective data from August 1994 to January 2011 were analyzed at our center. The various devices' implant time, the types of devices, the rates and causes of LOSC, and the procedures and results of LOSC were analyzed and evaluated. RESULTS: A total of 1729 endovascular aneurysm repairs were performed in our single center (Nuremberg South Hospital) with 13 various devices within 17 years. The median follow-up period was 51 months (range 9-119 months). Among them, 77 patients with infrarenal abdominal aortic aneurysms received LOSC. The LOSC rate was 4.5 % (77 of 1729). The LOSC rates were significantly different before and after January 2002 (p < 0.001). The reasons of LOSC were mainly large type I endoleaks (n = 51) that were hard to repair by endovascular techniques. For the LOSC procedure, 71 cases were elective and 6 were emergent. The perioperative mortality was 5.2 % (4 of 77): 1 was elective (due to septic shock) and 3 were urgent (due to hemorrhagic shock). CONCLUSION: Large type I endoleaks were the main reasons for LOSC. The improvement of devices and operators' experience may decrease the LOSC rate. Urgent LOSC resulted in a high mortality rate, while selective LOSC was relatively safe with significantly lower mortality rate. Early intervention, full preparation, and timely LOSC are important for patients who require LOSC.", "author" : [ { "dropping-particle" : "", "family" : "Wu", "given" : "Z", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Xu", "given" : "L", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Qu", "given" : "L", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Raithel", "given" : "D", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Cardiovasc Intervent Radiol", "id" : "ITEM-1", "issue" : "1", "issued" : { "date-parts" : [ [ "2015" ] ] }, "note" : "Wu, Ziheng\nXu, Liang\nQu, Lefeng\nRaithel, Dieter\neng\n2014/05/30 06:00\nCardiovasc Intervent Radiol. 2015 Feb;38(1):53-9. doi: 10.1007/s00270-014-0909-y. Epub 2014 May 30.", "page" : "53-59", "title" : "Seventeen years' experience of late open surgical conversion after failed endovascular abdominal aortic aneurysm repair with 13 variant devices", "type" : "article-journal", "volume" : "38" }, "uris" : [ "http://www.mendeley.com/documents/?uuid=e3625df0-1315-4147-bafd-d9525eecc7b2" ] }, { "id" : "ITEM-2", "itemData" : { "DOI" : "10.1016/j.jvs.2013.07.106", "ISBN" : "1097-6809 (Electronic)\r0741-5214 (Linking)", "PMID" : "24139568", "abstract" : "OBJECTIVE: Endovascular aortic aneurysm repair (EVAR) is widely used for the treatment of abdominal aortic aneurysms. Complications secondary to EVAR are also treated with endovascular techniques. When this is not applicable, open surgical repair is mandatory. This study aims to present our experience in open surgical repair after failed EVAR. METHODS: Within the period from 2004 through 2013, 18 patients (17 men; mean age, 73.9 years) were operated on because of EVAR failure due to persistent type II endoleak (n = 10), type I or III endoleak (n = 3), mixed-type endoleaks (n = 2), stent graft thrombosis (n = 2), and aortoenteric fistulae (n = 1). Stent grafts used for EVAR were Zenith (n = 8), Talent (n = 4), Excluder (n = 4), and Anaconda (n = 2). RESULTS: Mean time interval between EVAR and open conversion was 36 months (range, 2-120 months). Fifteen (83.3%) operations were elective, and three (16.7%) were urgent due to aneurysm rupture (n = 2) and aortoenteric fistula (n = 1). Six (33.3%) patients with type II endoleak were treated with simple ligation of the culprit vessels, without aortic clamping and stent graft explantation. In six (33.3%) patients, the stent graft was partially removed except from the segment attached to the proximal neck, while in five (27.8%) patients, complete removal of the stent graft was necessary. Finally, in one patient, with type III endoleak, a hybrid endovascular and open repair was performed. Clamping of the aorta was necessary in 12 (66.7%) patients (infrarenal, n = 10 or suprarenal, n = 2). Overall operative mortality was 5.6%. Postoperative complications included one abdominal wall defect requiring surgical revision and paroxysmal atrial fibrillation both in the same patient, and one case of pulmonary infection, requiring prolonged intubation and intensive care unit stay for 6 days. CONCLUSIONS: Late open conversion after failed EVAR remains challenging. Avoidance of aortic cross-clamping and if possible, partial or total preservation of the stent graft may improve outcomes in terms of operative mortality and morbidity. Elective operations seem to be associated with better outcomes, prompting thus for close follow-up of EVAR patients and early decision for conversion if other options are doubtful.", "author" : [ { "dropping-particle" : "", "family" : "Klonaris", "given" : "C", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Lioudaki", "given" : "S", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Katsargyris", "given" : "A", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Psathas", "given" : "E", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Kouvelos", "given" : "G", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Doulaptsis", "given" : "M", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Verikokos", "given" : "C", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Kouraklis", "given" : "G", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "J Vasc Surg", "id" : "ITEM-2", "issue" : "2", "issued" : { "date-parts" : [ [ "2014" ] ] }, "note" : "Klonaris, Chris\nLioudaki, Stella\nKatsargyris, Athanasios\nPsathas, Emmanouil\nKouvelos, George\nDoulaptsis, Mikes\nVerikokos, Chris\nKouraklis, Gregory\neng\n2013/10/22 06:00\nJ Vasc Surg. 2014 Feb;59(2):291-7. doi: 10.1016/j.jvs.2013.07.106. Epub 2013 Oct 16.", "page" : "291-297", "title" : "Late open conversion after failed endovascular aortic aneurysm repair", "type" : "article-journal", "volume" : "59" }, "uris" : [ "http://www.mendeley.com/documents/?uuid=c7bebf4d-fc34-49b2-87ec-1cdad4e8ee68" ] } ], "mendeley" : { "formattedCitation" : "215,216", "plainTextFormattedCitation" : "215,216", "previouslyFormattedCitation" : "215,216" }, "properties" : { }, "schema" : "https://github.com/citation-style-language/schema/raw/master/csl-citation.json" }215,216[Au: all types or type III specifically? All types of endoleaks]
Relining with placement of a 2nd stent-graft inside the 1st stent-graftStent-graft migration [Au: please complete]
Very difficult to find recent articles on thatsome old articles with the 1st generation devices report up to 8% but this is not representative to the new devices(Stent graft migration after endovascular aneurysm repair: importance of proximal fixation.
Zarins CK, Bloch DA, Crabtree T, Matsumoto AH, White RA, Fogarty TJ. J Vasc Surg. 2003 Dec;38(6):1264-72Caudal movement of the stent-graft due to insufficient proximal attachment
Can lead to proximal type Ia endoleakManagement of migration can include the placement of additional stent-grafts proximally. Increasing fixation of the stent-graft to the aortic wall with the use of endoanchors can be also consideredADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "ISBN" : "1827-191X (Electronic)\r0021-9509 (Linking)", "PMID" : "25519514", "abstract" : "Effective proximal sealing, especially in the long-term, remains a limitation of contemporary endovascular aortic aneurysm repair (EVAR). Endostaples that fixate the proximal stent-graft to the aortic neck wall, aiming for better apposition and proximal sealing have been recently introduced in clinical practice to address this problem. Initial experimental studies have shown that endostaples can increase proximal stent-graft fixation to levels equivalent or superior to that of a hand-sewn anastomosis. Further clinical studies aimed to investigate whether this increased proximal fixation results in reduced migration and better sealing with lower rates of type I endoleak. The present chapter discusses the efficacy of endostaples in reducing migration and type I endoleak after EVAR, based on published clinical data.", "author" : [ { "dropping-particle" : "", "family" : "Katsargyris", "given" : "A", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Oikonomou", "given" : "K", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Nagel", "given" : "S", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Giannakopoulos", "given" : "T", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Lg Verhoeven", "given" : "E", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "J Cardiovasc Surg (Torino)", "id" : "ITEM-1", "issue" : "3", "issued" : { "date-parts" : [ [ "2015" ] ] }, "note" : "Katsargyris, A\nOikonomou, K\nNagel, S\nGiannakopoulos, T\nLg Verhoeven, E\neng\nReview\nItaly\n2014/12/19 06:00\nJ Cardiovasc Surg (Torino). 2015 Jun;56(3):363-8. Epub 2014 Dec 18.", "page" : "363-368", "title" : "Endostaples: are they the solution to graft migration and Type I endoleaks?", "type" : "article-journal", "volume" : "56" }, "uris" : [ "http://www.mendeley.com/documents/?uuid=3876587f-9aee-4743-bce4-c4034ae34ac1" ] } ], "mendeley" : { "formattedCitation" : "217", "plainTextFormattedCitation" : "217", "previouslyFormattedCitation" : "217" }, "properties" : { }, "schema" : "https://github.com/cita t i o n - s t y l e - l a n g u a g e / s c h e m a / r a w / m a s t e r / c s l - c i t a t i o n . j s o n " } 2 1 7 . G r a f t - l i m b o c c l u s i o n 1 . 7 "3 . 7 % [ A u : P l e a s e r e f e r e n c e t h i s d a t a . ] E s s e n t i a l s o f e n d o v a s c u l a r a b d o m i n a l a o r t i c a n e u r y s m r e p a i r i m a g i n g : p o s t p r o c e d u r e s u r v e i l l a n c e a n d c o m p l i c a t i o n s . P i c e l A C , Kansal N.AJR Am J Roentgenol. 2014 Oct;203(4):W358-72 [Au: please briefly define] Thrombosis of the iliac graft-limb Treatment includes thrombectomy with adjunct stenting if needed. If thrombectomy fails, blood flow can be re-established with a femoral-femoral artery crossover surgical bypass.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1007/BF02021777", "ISBN" : "0890-5096 (Print)\r0890-5096 (Linking)", "PMID" : "1997075", "abstract" : "Between 1973 and 1989, 39 femorofemoral crossover bypasses were performed to treat unilateral noninfective complications of aortoiliac surgery. The initial revascularization procedure, performed an average of 79.5 months previously, was an aortobifemoral bypass in 29 cases, an aorto- or iliofemoral bypass in six cases, an inlay graft for abdominal aortic aneurysm and aortoiliac endarterectomy in two cases each. The indications for femorofemoral crossover bypass included prosthetic occlusion in 35 cases, thrombosed false aneurysm in two, and further degradation after endarterectomy (iliac stenosis and occlusion in one case each). There was no operative mortality. One patient with acute ischemia upon admission and another with distal gangrene required below-knee and forefoot amputations, respectively. No amputations were required during the rest of the follow-up period. Three repeat aortobifemoral bypasses were performed because of occurrence of aortic or inflow vessel lesions. Primary and secondary actuarial five year patency rates for femorofemoral crossover bypasses were 59.7% and 78.4%, respectively. Femorofemoral crossover bypass can extend the benefits derived from direct aortoiliac surgery with low mortality and morbidity in the absence of associated aortic pathology (false aneurysm at the aortic implantation site or severe obstructive lesions).", "author" : [ { "dropping-particle" : "", "family" : "Francois", "given" : "F", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Picard", "given" : "E", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Nicaud", "given" : "P", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Albat", "given" : "B", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Thevenet", "given" : "A", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Ann Vasc Surg", "id" : "ITEM-1", "issue" : "1", "issued" : { "date-parts" : [ [ "1991" ] ] }, "note" : "Francois, F\nPicard, E\nNicaud, P\nAlbat, B\nThevenet, A\neng\nNetherlands\n1991/01/01 00:00\nAnn Vasc Surg. 1991 Jan;5(1):46-9. doi: 10.1007/BF02021777.", "page" : "46-49", "title" : "Femorofemoral crossover bypass for noninfective complications of aortoiliac surgery", "type" : "article-journal", "volume" : "5" }, "uris" : [ "http://www.mendeley.com/documents/?uuid=d5461bf6-0b4a-48bf-9b85-0181265ddfb3" ] } ], "mendeley" : { "formattedCitation" : "202", "plainTextFormattedCitation" : "202", "previouslyFormattedCitation" : "202" }, "properties" : { }, "schema" : "https://github.com/citation-style-language/schema/raw/master/csl-citation.json" }202[Au: treatment copied from graft limb occlusion after open surgery, is it OK? OK]Stent-graft infection0<1% [Au: please reference this data] Essentials of endovascular abdominal aortic aneurysm repair imaging: postprocedure surveillance and complications.
Picel AC, Kansal N.
AJR Am J Roentgenol. 2014 Oct;203(4):W358-72Infection of the implanted stent-graft as suggested by clinical, radiological and laboratory criteria[Au: please briefly define] Although conservative treatment with life-long antibiotics has been sporadically reported to be successful, definite treatment requires explantation of the infected graft.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1177/1358863X15612574", "ISBN" : "1477-0377 (Electronic)\r1358-863X (Linking)", "PMID" : "26584886", "abstract" : "Infections of vascular grafts are associated with significant mortality and morbidity risk and cost an estimated $640 million annually in the United States. Clinical presentation varies by time elapsed from implantation and by surgical site. A thorough history and physical examination in conjunction with a variety of imaging modalities is often essential to diagnosis. For infected aortic grafts, there are several options for treatment, including graft excision with extra-anatomic bypass, in situ reconstruction, or reconstruction with the neo-aortoiliac system. The management of infected endovascular aortic grafts is similar. For infected peripheral bypasses, graft preservation techniques can be utilized, but in cases where it is not possible, graft removal and revascularization through uninfected tissue planes is necessary. Infected dialysis access can be surgically treated by complete or subtotal graft excision. Diagnosis, general management, and surgical approaches to infected vascular grafts are discussed in this review.", "author" : [ { "dropping-particle" : "", "family" : "Kilic", "given" : "A", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Arnaoutakis", "given" : "D J", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Reifsnyder", "given" : "T", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Black 3rd", "given" : "J H", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Abularrage", "given" : "C J", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Perler", "given" : "B A", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Lum", "given" : "Y W", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Vasc Med", "id" : "ITEM-1", "issue" : "1", "issued" : { "date-parts" : [ [ "2016" ] ] }, "note" : "Kilic, Arman\nArnaoutakis, Dean J\nReifsnyder, Thomas\nBlack, James H 3rd\nAbularrage, Christopher J\nPerler, Bruce A\nLum, Ying Wei\neng\nReview\nEngland\nLondon, England\n2015/11/21 06:00\nVasc Med. 2016 Feb;21(1):53-60. doi: 10.1177/1358863X15612574. Epub 2015 Nov 19.", "page" : "53-60", "title" : "Management of infected vascular grafts", "type" : "article-journal", "volume" : "21" }, "uris" : [ "http://www.mendeley.com/documents/?uuid=53eb11e8-2b55-43ce-b5b6-848845b761e1" ] } ], "mendeley" : { "formattedCitation" : "206", "plainTextFormattedCitation" : "206", "previouslyFormattedCitation" : "206" }, "properties" : { }, "schema" : "https://github.com/citation-style-language/schema/raw/master/csl-citation.json" }206 Revascularization of the lower limbs can be achieved with different options, including ligation of the aorta and axillo-bifemoral bypass, in situ use of cryo-preserved aortic homografts or antibiotic-soaked prosthetic grafts, or autologous reconstruction using the femoral veins.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1016/j.ejvs.2016.11.006", "ISBN" : "1532-2165 (Electronic)\r1078-5884 (Linking)", "PMID" : "28010954", "author" : [ { "dropping-particle" : "", "family" : "Debus", "given" : "E S", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Diener", "given" : "H", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Eur J Vasc Endovasc Surg", "id" : "ITEM-1", "issue" : "2", "issued" : { "date-parts" : [ [ "2017" ] ] }, "note" : "Debus, E S\nDiener, H\neng\nEditorial\nEngland\n2016/12/25 06:00\nEur J Vasc Endovasc Surg. 2017 Feb;53(2):151-152. doi: 10.1016/j.ejvs.2016.11.006. Epub 2016 Dec 20.", "page" : "151-152", "title" : "Reconstructions Following Graft Infection: An Unsolved Challenge", "type" : "article-journal", "volume" : "53" }, "uris" : [ "http://www.mendeley.com/documents/?uuid=2ab5d1fe-8bf4-4886-8222-5bf540c6f8ce" ] }, { "id" : "ITEM-2", "itemData" : { "DOI" : "10.1016/j.avsg.2017.04.041", "ISBN" : "1615-5947 (Electronic)\r0890-5096 (Linking)", "PMID" : "28495536", "abstract" : "BACKGROUND: The aim of this case series is to report the results of our center in the surgical treatment of infected abdominal aortic grafts using the neoaortoiliac system (NAIS) procedure. METHODS: Four male and 2 female patients underwent an NAIS repair after endovascular (n = 3), open (n = 2), or combined surgery (n = 1) in our center. Mean age was 73 +/- 5.2 years. Graft infection was diagnosed by computed tomography angiography (CTA), and only in 2 cases further imaging was necessary. The diagnosis was set at average 6.2 years after the initial procedure. RESULTS: Four patients underwent a standard pantaloon NAIS procedure, 1 patient with a small aortic diameter received 1 femoral vein as aortoaortic interposition graft, and 1 patient received a unilateral aortoiliac bypass; all patients received autologous femoral veins grafts. Thirty-day mortality was zero, with in-hospital mortality of 1 patient (16.7%). Mean hospital stay was 27 +/- 4.9 days, with mean intensive care unit stay of 2.2 days (range: 1-3). During follow-up (mean: 6.17 months, range: 1-24 months), 2 patients presented with thigh wound complications, one of which required surgical revision. One patient was readmitted due to upper gastrointestinal (GI) bleeding as a side effect of anticoagulation, without the presence of ulcer or other GI pathology. CONCLUSIONS: In our early experience, NAIS showed to be a demanding procedure for both the patient and the surgical team. It avoids however the disadvantages of extra-anatomic bypass and other methods used to treat aortic graft infection. Larger study groups are necessary to support these findings.", "author" : [ { "dropping-particle" : "", "family" : "Klonaris", "given" : "C", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Patelis", "given" : "N", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Katsargyris", "given" : "A", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Athanasiadis", "given" : "D", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Alexandrou", "given" : "A", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Liakakos", "given" : "T", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Ann Vasc Surg", "id" : "ITEM-2", "issued" : { "date-parts" : [ [ "2017" ] ] }, "note" : "Klonaris, Chris\nPatelis, Nikolaos\nKatsargyris, Athanasios\nAthanasiadis, Dimitrios\nAlexandrou, Andreas\nLiakakos, Theodoros\neng\nNetherlands\n2017/05/13 06:00\nAnn Vasc Surg. 2017 Oct;44:419.e19-419.e25. doi: 10.1016/j.avsg.2017.04.041. Epub 2017 May 8.", "page" : "419 e19-419 e25", "title" : "Neoaortoiliac System Procedure to Treat Infected Aortic Grafts", "type" : "article-journal", "volume" : "44" }, "uris" : [ "http://www.mendeley.com/documents/?uuid=4ea5746c-2405-44c8-9d83-5d726f6fe4b4" ] } ], "mendeley" : { "formattedCitation" : "207,208", "plainTextFormattedCitation" : "207,208", "previouslyFormattedCitation" : "207,208" }, "properties" : { }, "schema" : "https://github.com/citation-style-language/schema/raw/master/csl-citation.json" }207,208[Au: treatment copied from graft infection after open surgery, is it OK? OK]Sac expansion and secondary ruptureSchanzer et al. reported that the rate of AAA sac expansion after EVAR may be as high as 41% at 5 years, while other authors report a lower incidence.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1161/CIRCULATIONAHA.110.014902\rCIRCULATIONAHA.110.014902 [pii]", "ISBN" : "1524-4539 (Electronic)\r0009-7322 (Linking)", "PMID" : "21478500", "abstract" : "BACKGROUND: The majority of infrarenal abdominal aortic aneurysm (AAA) repairs in the United States are performed with endovascular methods. Baseline aortoiliac arterial anatomic characteristics are fundamental criteria for appropriate patient selection for endovascular aortic repair (EVAR) and key determinants of long-term success. We evaluated compliance with anatomic guidelines for EVAR and the relationship between baseline aortoiliac arterial anatomy and post-EVAR AAA sac enlargement. METHODS AND RESULTS: Patients with pre-EVAR and at least 1 post-EVAR computed tomography scan were identified from the M2S, Inc. imaging database (1999 to 2008). Preoperative baseline aortoiliac anatomic characteristics were reviewed for each patient. Data relating to the specific AAA endovascular device implanted were not available. Therefore, morphological measurements were compared with the most liberal and the most conservative published anatomic guidelines as stated in each manufacturer's instructions for use. The primary study outcome was post-EVAR AAA sac enlargement (>5-mm diameter increase). In 10 228 patients undergoing EVAR, 59% had a maximum AAA diameter below the 55-mm threshold at which intervention is recommended over surveillance. Only 42% of patients had anatomy that met the most conservative definition of device instructions for use; 69% met the most liberal definition of device instructions for use. The 5-year post-EVAR rate of AAA sac enlargement was 41%. Independent predictors of AAA sac enlargement included endoleak, age >/= 80 years, aortic neck diameter >/= 28 mm, aortic neck angle >60 degrees , and common iliac artery diameter >20 mm. CONCLUSION: In this multicenter observational study, compliance with EVAR device guidelines was low and post-EVAR aneurysm sac enlargement was high, raising concern for long-term risk of aneurysm rupture.", "author" : [ { "dropping-particle" : "", "family" : "Schanzer", "given" : "A", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Greenberg", "given" : "R K", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Hevelone", "given" : "N", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Robinson", "given" : "W P", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Eslami", "given" : "M H", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Goldberg", "given" : "R J", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Messina", "given" : "L", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Circulation", "edition" : "2011/04/12", "id" : "ITEM-1", "issue" : "24", "issued" : { "date-parts" : [ [ "2011" ] ] }, "language" : "eng", "note" : "Schanzer, Andres\nGreenberg, Roy K\nHevelone, Nathanael\nRobinson, William P\nEslami, Mohammad H\nGoldberg, Robert J\nMessina, Louis\nMulticenter Study\nResearch Support, Non-U.S. Gov't\nUnited States\nCirculation\nCirculation. 2011 Jun 21;123(24):2848-55. doi: 10.1161/CIRCULATIONAHA.110.014902. Epub 2011 Apr 10.", "page" : "2848-2855", "title" : "Predictors of abdominal aortic aneurysm sac enlargement after endovascular repair", "type" : "article-journal", "volume" : "123" }, "uris" : [ "http://www.mendeley.com/documents/?uuid=8e73d641-604c-4702-9a5e-6f4fb054ca02" ] } ], "mendeley" : { "formattedCitation" : "218", "plainTextFormattedCitation" : "218", "previouslyFormattedCitation" : "218" }, "properties" : { }, "schema" : "https://github.com/citation-style-language/schema/raw/master/csl-citation.json" }218[Au: could you provide a range, as for the other complications? Again very heterogenous (0-41%]Since EVAR leaves the aneurysmal sac in situ, and blood supply to this sac is sometimes maintained (endoleak), sac expansion may occur during follow-up. If left untreated sac expansion may result in late AAA rupture despite previous EVAR. A recent meta-analysis of 16,974 EVAR procedures reported a late rupture rate of 0.9% after EVAR.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1177/1526602815601405", "ISSN" : "1545-1550", "PMID" : "26286073", "abstract" : "PURPOSE To report a systematic literature review of late rupture of abdominal aortic aneurysm (AAA) after endovascular aneurysm repair (EVAR) and the results of a pooled analysis of causes, treatment, and outcomes. METHODS Electronic information sources and bibliographic reference lists were interrogated using a combination of free text and controlled vocabulary searches; 11 articles were ultimately identified that fulfilled the inclusion criteria. The articles reported a total of 190 patients who were included in the qualitative and quantitative synthesis. Mortality within 30 days or during the admission with aneurysm rupture was a primary endpoint; major perioperative morbidity was a secondary endpoint. A meta-analysis was performed for 30-day/in-hospital mortality using the random effects model. RESULTS A total of 152 ruptures occurred after 16,974 EVAR procedures reported by 8 of the case series, giving an incidence of 0.9% [95% confidence interval (CI) 0.77 to 1.05]. The mean time to rupture was 37 months. Twenty-nine percent (95% CI 20 to 39) of the patients had at least one previous secondary endovascular intervention following the initial EVAR, and 37% (95% CI 30 to 45) were not compliant with surveillance. Type I and III endoleaks were the predominant causes of rupture. Open surgical treatment was undertaken in 61% (95% CI 53 to 68) of the patients who underwent treatment. The pooled estimate for perioperative mortality was 32% (95% CI 24 to 41). A significantly lower mortality was found with endovascular treatment than open surgical management (p=0.027). CONCLUSION Graft-related endoleaks appear to be the predominant causes of late aneurysm rupture. Quality of and compliance with post-EVAR surveillance are important factors in late rupture; a large proportion of late ruptures are amenable to endovascular treatment.", "author" : [ { "dropping-particle" : "", "family" : "Antoniou", "given" : "George A", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Georgiadis", "given" : "George S", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Antoniou", "given" : "Stavros A", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Neequaye", "given" : "Simon", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Brennan", "given" : "John A", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Torella", "given" : "Francesco", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Vallabhaneni", "given" : "S Rao", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Journal of endovascular therapy : an official journal of the International Society of Endovascular Specialists", "id" : "ITEM-1", "issue" : "5", "issued" : { "date-parts" : [ [ "2015", "10", "18" ] ] }, "page" : "734-44", "title" : "Late Rupture of Abdominal Aortic Aneurysm After Previous Endovascular Repair: A Systematic Review and Meta-analysis.", "type" : "article-journal", "volume" : "22" }, "uris" : [ "http://www.mendeley.com/documents/?uuid=d3671328-3d28-36d1-9d7e-7f43fe283c7f" ] } ], "mendeley" : { "formattedCitation" : "219", "plainTextFormattedCitation" : "219", "previouslyFormattedCitation" : "219" }, "properties" : { }, "schema" : "https://github.com/citation-style-language/schema/raw/master/csl-citation.json" }219Treatment includes either a second endovascular repair or open surgical conversion with removal of the stent-graft. Both operations are associated with higher mortality and morbidity rates compared to primary EVAR or open repair.Open surgeryGraft-limb occlusionup to 2% [Au: please reference] Graft-related complications after abdominal aortic aneurysm repair: reassurance from a 36-year population-based experience.
Hallett JW Jr, Marshall DM, Petterson TM, et al.
J Vasc Surg. 1997 Feb;25(2):277-84;may cause symptoms of acute limb ischemiaTreatment includes thrombectomy with adjunct stenting if needed. If thrombectomy fails, blood flow can be re-established with a femoral-femoral artery crossover surgical bypass.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1007/BF02021777", "ISBN" : "0890-5096 (Print)\r0890-5096 (Linking)", "PMID" : "1997075", "abstract" : "Between 1973 and 1989, 39 femorofemoral crossover bypasses were performed to treat unilateral noninfective complications of aortoiliac surgery. The initial revascularization procedure, performed an average of 79.5 months previously, was an aortobifemoral bypass in 29 cases, an aorto- or iliofemoral bypass in six cases, an inlay graft for abdominal aortic aneurysm and aortoiliac endarterectomy in two cases each. The indications for femorofemoral crossover bypass included prosthetic occlusion in 35 cases, thrombosed false aneurysm in two, and further degradation after endarterectomy (iliac stenosis and occlusion in one case each). There was no operative mortality. One patient with acute ischemia upon admission and another with distal gangrene required below-knee and forefoot amputations, respectively. No amputations were required during the rest of the follow-up period. Three repeat aortobifemoral bypasses were performed because of occurrence of aortic or inflow vessel lesions. Primary and secondary actuarial five year patency rates for femorofemoral crossover bypasses were 59.7% and 78.4%, respectively. Femorofemoral crossover bypass can extend the benefits derived from direct aortoiliac surgery with low mortality and morbidity in the absence of associated aortic pathology (false aneurysm at the aortic implantation site or severe obstructive lesions).", "author" : [ { "dropping-particle" : "", "family" : "Francois", "given" : "F", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Picard", "given" : "E", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Nicaud", "given" : "P", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Albat", "given" : "B", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Thevenet", "given" : "A", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Ann Vasc Surg", "id" : "ITEM-1", "issue" : "1", "issued" : { "date-parts" : [ [ "1991" ] ] }, "note" : "Francois, F\nPicard, E\nNicaud, P\nAlbat, B\nThevenet, A\neng\nNetherlands\n1991/01/01 00:00\nAnn Vasc Surg. 1991 Jan;5(1):46-9. doi: 10.1007/BF02021777.", "page" : "46-49", "title" : "Femorofemoral crossover bypass for noninfective complications of aortoiliac surgery", "type" : "article-journal", "volume" : "5" }, "uris" : [ "http://www.mendeley.com/documents/?uuid=d5461bf6-0b4a-48bf-9b85-0181265ddfb3" ] } ], "mendeley" : { "formattedCitation" : "202", "plainTextFormattedCitation" : "202", "previouslyFormattedCitation" : "202" }, "properties" : { }, "schema" : "https://github.com/citation-style-language/schema/raw/master/csl-citation.json" }202Para-anastomotic aneurysmup to 3% [Au: please reference] Graft-related complications after abdominal aortic aneurysm repair: reassurance from a 36-year population-based experience.
Hallett JW Jr, Marshall DM, Petterson TM, et al.
J Vasc Surg. 1997 Feb;25(2):277-84;Either true aneurysm due to progression of disease, or pseudoaneurysm caused by destruction of the anastomosis line between the graft and the native aorta. Pseudoaneurysms may indicate graft infection.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "ISBN" : "0967-2109 (Print)\r0967-2109 (Linking)", "PMID" : "10840204", "abstract" : "The aim of the study is a retrospective review of clinical presentation and management of paraanastomotic aneurysms of the abdominal aorta (PAAA) surgically treated in our Department. From January 1984 to December 1998, 2183 aortic prosthetic grafts were implanted. During the same period, 24 patients were treated for PAAA, 19 false and five true aneurysms. Symptoms were present in 10 patients. Surgical management included tube grafting interposition (14), aortobifemoral bypass (2), graft removal with extraanatomic bypass (2) and with in situ revascularization by arterial homograft (4). Nine patients died during operation or in the early postoperative period, six died during follow-up. Mortality in symptomatic patients was 70%, while in asymptomatic group was 14% (P=0.01). Rupture of false PAAA was very frequent (47% of cases). PAAA are infrequent complications of proximal aortic graft revascularization and tend to be asymptomatic until rupture occurs. The incidence of mortality is very different in asymptomatic versus symptomatic group; rupture is particularly frequent in false PAAA, which must soon undergo surgery when diagnosed. Since PAAA may develop at any time after surgery, their incidence increase in relationship with the length of postoperative interval: therefore, all patients submitted to abdominal graft revascularization need a lifetime surveillance program.", "author" : [ { "dropping-particle" : "", "family" : "Locati", "given" : "P", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Socrate", "given" : "A M", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Costantini", "given" : "E", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Cardiovasc Surg", "id" : "ITEM-1", "issue" : "4", "issued" : { "date-parts" : [ [ "2000" ] ] }, "note" : "Locati, P\nSocrate, A M\nCostantini, E\neng\nEngland\nLondon, England\n2000/06/07 09:00\nCardiovasc Surg. 2000 Jun;8(4):274-9.", "page" : "274-279", "title" : "Paraanastomotic aneurysms of the abdominal aorta: a 15-year experience review", "type" : "article-journal", "volume" : "8" }, "uris" : [ "http://www.mendeley.com/documents/?uuid=85fb4286-acca-40ee-9cd0-db5ea7bef30c" ] }, { "id" : "ITEM-2", "itemData" : { "ISBN" : "0741-5214 (Print)\r0741-5214 (Linking)", "PMID" : "8377236", "abstract" : "PURPOSE: Aneurysm formation after abdominal aortic bypass reconstruction is an infrequent but underestimated complication. Aneurysms may occur after aortic prosthetic reconstruction for both occlusive and aneurysmal disease, may occur early or late, and may be classified as a pseudoaneurysm or true aneurysm. METHODS: Thirty-one cases in 29 patients treated at a tertiary referral center from 1980 to 1992 were retrospectively reviewed. Iliac and femoral aneurysms were excluded. The indication for initial abdominal aortic grafting had been aneurysmal disease in 19 patient and occlusive disease in 10 patients. RESULTS: There were 25 pseudoaneurysms and six true aneurysms, the latter followed grafting for aneurysmal disease. The current aneurysm (mean size 7.1 cm) was at the proximal aortic anastomosis in 27 cases and at the distal aortic anastomosis in two cases. Symptoms at presentation included abdominal pain (14), mass (12), claudication (9), back pain (6), and gastrointestinal bleeding (3). Surgical management included interposition tube grafting (16), aortoiliofemoral bypass (9), and graft removal with extraanatomic bypass (3). The overall operative morbidity rate was 73%, and mortality rate was 21%. CONCLUSIONS: Paraanastomotic aortic aneurysms are being increasingly recognized and are associated with high morbidity and mortality rates. Patients should be periodically studied after aortic grafting with abdominal ultrasonography for early detection of this potentially serious complication. Elective surgical repair is advocated in the effort to minimize morbidity rates.", "author" : [ { "dropping-particle" : "", "family" : "Allen", "given" : "R C", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Schneider", "given" : "J", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Longenecker", "given" : "L", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Smith 3rd", "given" : "R B", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Lumsden", "given" : "A B", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "J Vasc Surg", "id" : "ITEM-2", "issue" : "3", "issued" : { "date-parts" : [ [ "1993" ] ] }, "note" : "Allen, R C\nSchneider, J\nLongenecker, L\nSmith, R B 3rd\nLumsden, A B\neng\n1993/09/01 00:00\nJ Vasc Surg. 1993 Sep;18(3):424-31; discussion 431-2.", "page" : "422-424", "title" : "Paraanastomotic aneurysms of the abdominal aorta", "type" : "article-journal", "volume" : "18" }, "uris" : [ "http://www.mendeley.com/documents/?uuid=5d265170-36ac-489a-b2c2-0f243fbbb181" ] } ], "mendeley" : { "formattedCitation" : "203,204", "plainTextFormattedCitation" : "203,204", "previouslyFormattedCitation" : "203,204" }, "properties" : { }, "schema" : "https://github.com/citation-style-language/schema/raw/master/csl-citation.json" }203,204Conventional treatment of para-anastomotic aneurysms includes re-do surgery, especially in the case of infection. If graft infection is excluded, relining and extension of the repair with a stent-graft can offer a less invasive treatment.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1007/s10016-004-0002-0", "ISBN" : "0890-5096 (Print)\r0890-5096 (Linking)", "PMID" : "15354628", "abstract" : "The aim of this study was to evaluate the effectiveness of endovascular repair of anastomotic and true aortic and iliac aneurysms occurring after prior polyester graft repair for abdominal aortic aneurysms (AAA) or aortoiliac obstructive disease. Between July 1999 and January 2003, 14 patients underwent endovascular treatment of aortic pseudoaneurysms (n = 6) or iliac aneurysms (2 patients with pseudoaneurysms and 6 patients with true aneurysms) occurring 4 to 18.4 years (mean, 8.8 years) after open aortic surgery. No patient had symptoms or positive parameters for infection of the original polyester graft. Eleven patients, including one patient with both a proximal anastomotic and a true iliac aneurysm, were treated with AneuRx (n = 8), Talent (n = 2), or Quantum LP (n = 1) bifurcated stent grafts. Three patients with an infrarenal anastomotic pseudoaneurysm were treated with a tube stent graft (Talent [n = 2] and AneuRx [n = 1]). Endovascular stent grafts were successfully inserted in all patients. Procedure-related complications or death was not seen. During a median follow-up of 12 months (range, 3-40) all anastomotic and/or true aneurysms treated with bifurcated stent grafts maintained excluded. However, two out of three patients, treated with a tube graft for proximal aneurysm exclusion, were converted. In both patients the tube stent graft did not migrate from the level of the renal arteries but fixation failed between the stent graft and the previous polyester graft, creating endotension in the thrombus of the aneurysm sac. In one of these patients the old anastomotic aneurysm ruptured 16 months after stent graft placement and the patient died 1 day after conversion because of mesenterial ischemia. At 1 year follow-up the second patient was converted successfully after enlargement of his anastomotic aneurysm due to similar disconnection between the stent graft and the polyester graft. From this experience with endovascular stent grafts, we conclude that these can be used successfully to exclude anastomotic or true aneurysms after open aortic surgery. Exclusion of aneurysms at the proximal anastomosis with tube stent grafts is apparently not durable because of the insecure distal fixation in polyester grafts. Endovascular repair with bifurcated stent grafts, however, seems to be effective at midterm follow-up.", "author" : [ { "dropping-particle" : "", "family" : "Herwaarden", "given" : "J A", "non-dropping-particle" : "van", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Waasdorp", "given" : "E J", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Bendermacher", "given" : "B L", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Berg", "given" : "J C", "non-dropping-particle" : "van den", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Teijink", "given" : "J A", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Moll", "given" : "F L", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Ann Vasc Surg", "id" : "ITEM-1", "issue" : "3", "issued" : { "date-parts" : [ [ "2004" ] ] }, "note" : "van Herwaarden, Joost A\nWaasdorp, Evert J\nBendermacher, Bianca L W\nvan den Berg, Jos C\nTeijink, Joep A W\nMoll, Frans L\neng\nEvaluation Studies\nNetherlands\n2004/09/10 05:00\nAnn Vasc Surg. 2004 May;18(3):280-6. doi: 10.1007/s10016-004-0002-0.", "page" : "280-286", "title" : "Endovascular repair of paraanastomotic aneurysms after previous open aortic prosthetic reconstruction", "type" : "article-journal", "volume" : "18" }, "uris" : [ "http://www.mendeley.com/documents/?uuid=4d6d22f8-36bf-4a91-ac96-c9b707758128" ] } ], "mendeley" : { "formattedCitation" : "205", "plainTextFormattedCitation" : "205", "previouslyFormattedCitation" : "205" }, "properties" : { }, "schema" : "https://github.com/citation-style-language/schema/raw/master/csl-citation.json" }205Graft infection (with or without concomitant aortoenteric fistula)0.2-1.3% [Au: please reference] Graft-related complications after abdominal aortic aneurysm repair: reassurance from a 36-year population-based experience.
Hallett JW Jr, Marshall DM, Petterson TM, et al.
J Vasc Surg. 1997 Feb;25(2):277-84;[Au: please briefly define] Infection of the implanted stent-graft as suggested by clinical, radiological and laboratory criteriaAlthough conservative treatment with life-long antibiotics has been sporadically reported to be successful, definite treatment requires explantation of the infected graft.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1177/1358863X15612574", "ISBN" : "1477-0377 (Electronic)\r1358-863X (Linking)", "PMID" : "26584886", "abstract" : "Infections of vascular grafts are associated with significant mortality and morbidity risk and cost an estimated $640 million annually in the United States. Clinical presentation varies by time elapsed from implantation and by surgical site. A thorough history and physical examination in conjunction with a variety of imaging modalities is often essential to diagnosis. For infected aortic grafts, there are several options for treatment, including graft excision with extra-anatomic bypass, in situ reconstruction, or reconstruction with the neo-aortoiliac system. The management of infected endovascular aortic grafts is similar. For infected peripheral bypasses, graft preservation techniques can be utilized, but in cases where it is not possible, graft removal and revascularization through uninfected tissue planes is necessary. Infected dialysis access can be surgically treated by complete or subtotal graft excision. Diagnosis, general management, and surgical approaches to infected vascular grafts are discussed in this review.", "author" : [ { "dropping-particle" : "", "family" : "Kilic", "given" : "A", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Arnaoutakis", "given" : "D J", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Reifsnyder", "given" : "T", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Black 3rd", "given" : "J H", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Abularrage", "given" : "C J", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Perler", "given" : "B A", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Lum", "given" : "Y W", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Vasc Med", "id" : "ITEM-1", "issue" : "1", "issued" : { "date-parts" : [ [ "2016" ] ] }, "note" : "Kilic, Arman\nArnaoutakis, Dean J\nReifsnyder, Thomas\nBlack, James H 3rd\nAbularrage, Christopher J\nPerler, Bruce A\nLum, Ying Wei\neng\nReview\nEngland\nLondon, England\n2015/11/21 06:00\nVasc Med. 2016 Feb;21(1):53-60. doi: 10.1177/1358863X15612574. Epub 2015 Nov 19.", "page" : "53-60", "title" : "Management of infected vascular grafts", "type" : "article-journal", "volume" : "21" }, "uris" : [ "http://www.mendeley.com/documents/?uuid=53eb11e8-2b55-43ce-b5b6-848845b761e1" ] } ], "mendeley" : { "formattedCitation" : "206", "plainTextFormattedCitation" : "206", "previouslyFormattedCitation" : "206" }, "properties" : { }, "schema" : "https://github.com/citation-style-language/schema/raw/master/csl-citation.json" }206 Revascularization of the lower limbs can be achieved with different options, including ligation of the aorta and axillo-bifemoral bypass, in situ use of cryo-preserved aortic homografts or antibiotic-soaked prosthetic grafts, or autologous reconstruction using the femoral veins.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1016/j.ejvs.2016.11.006", "ISBN" : "1532-2165 (Electronic)\r1078-5884 (Linking)", "PMID" : "28010954", "author" : [ { "dropping-particle" : "", "family" : "Debus", "given" : "E S", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Diener", "given" : "H", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Eur J Vasc Endovasc Surg", "id" : "ITEM-1", "issue" : "2", "issued" : { "date-parts" : [ [ "2017" ] ] }, "note" : "Debus, E S\nDiener, H\neng\nEditorial\nEngland\n2016/12/25 06:00\nEur J Vasc Endovasc Surg. 2017 Feb;53(2):151-152. doi: 10.1016/j.ejvs.2016.11.006. Epub 2016 Dec 20.", "page" : "151-152", "title" : "Reconstructions Following Graft Infection: An Unsolved Challenge", "type" : "article-journal", "volume" : "53" }, "uris" : [ "http://www.mendeley.com/documents/?uuid=2ab5d1fe-8bf4-4886-8222-5bf540c6f8ce" ] }, { "id" : "ITEM-2", "itemData" : { "DOI" : "10.1016/j.avsg.2017.04.041", "ISBN" : "1615-5947 (Electronic)\r0890-5096 (Linking)", "PMID" : "28495536", "abstract" : "BACKGROUND: The aim of this case series is to report the results of our center in the surgical treatment of infected abdominal aortic grafts using the neoaortoiliac system (NAIS) procedure. METHODS: Four male and 2 female patients underwent an NAIS repair after endovascular (n = 3), open (n = 2), or combined surgery (n = 1) in our center. Mean age was 73 +/- 5.2 years. Graft infection was diagnosed by computed tomography angiography (CTA), and only in 2 cases further imaging was necessary. The diagnosis was set at average 6.2 years after the initial procedure. RESULTS: Four patients underwent a standard pantaloon NAIS procedure, 1 patient with a small aortic diameter received 1 femoral vein as aortoaortic interposition graft, and 1 patient received a unilateral aortoiliac bypass; all patients received autologous femoral veins grafts. Thirty-day mortality was zero, with in-hospital mortality of 1 patient (16.7%). Mean hospital stay was 27 +/- 4.9 days, with mean intensive care unit stay of 2.2 days (range: 1-3). During follow-up (mean: 6.17 months, range: 1-24 months), 2 patients presented with thigh wound complications, one of which required surgical revision. One patient was readmitted due to upper gastrointestinal (GI) bleeding as a side effect of anticoagulation, without the presence of ulcer or other GI pathology. CONCLUSIONS: In our early experience, NAIS showed to be a demanding procedure for both the patient and the surgical team. It avoids however the disadvantages of extra-anatomic bypass and other methods used to treat aortic graft infection. Larger study groups are necessary to support these findings.", "author" : [ { "dropping-particle" : "", "family" : "Klonaris", "given" : "C", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Patelis", "given" : "N", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Katsargyris", "given" : "A", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Athanasiadis", "given" : "D", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Alexandrou", "given" : "A", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Liakakos", "given" : "T", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Ann Vasc Surg", "id" : "ITEM-2", "issued" : { "date-parts" : [ [ "2017" ] ] }, "note" : "Klonaris, Chris\nPatelis, Nikolaos\nKatsargyris, Athanasios\nAthanasiadis, Dimitrios\nAlexandrou, Andreas\nLiakakos, Theodoros\neng\nNetherlands\n2017/05/13 06:00\nAnn Vasc Surg. 2017 Oct;44:419.e19-419.e25. doi: 10.1016/j.avsg.2017.04.041. Epub 2017 May 8.", "page" : "419 e19-419 e25", "title" : "Neoaortoiliac System Procedure to Treat Infected Aortic Grafts", "type" : "article-journal", "volume" : "44" }, "uris" : [ "http://www.mendeley.com/documents/?uuid=4ea5746c-2405-44c8-9d83-5d726f6fe4b4" ] } ], "mendeley" : { "formattedCitation" : "207,208", "plainTextFormattedCitation" : "207,208", "previouslyFormattedCitation" : "207,208" }, "properties" : { }, "schema" : "https://github.com/citation-style-language/schema/raw/master/csl-citation.json" }207,208 For concomitant aortoenteric fistula, additional reconstruction of the enteric lesion is required.
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2 8 " # & G M ! *hIa hHe- 5B* \^J mH nH ph I} u $hIa hHe- B* ^J mH nH ph I} u *hIa hHe- 6B* ]^J mH nH ph I} uL , F 7 2 @ T | g 3 $a$gdHe- $1$ 7$ 8$ H$ ^`a$gdHe- f q r v , - 0 ) A B E \ g h k H Q R V " H N j hIa hHe- B* Uph I} hIa hHe- B* mH nH ph I} u U*hIa hHe- 5B* \^J mH nH ph I} u $hIa hHe- B* ^J mH nH ph I} u *hIa hHe- 6B* ]^J mH nH ph I} u>d endovascular repair of abdominal aortic aneurysms on quality of life. Br J Surg 100, 448455 (2013).
227. Kayssi, A., DeBord Smith, A., Roche-Nagle, G. & Nguyen, L. L. Health-related quality-of-life outcomes after open versus endovascular abdominal aortic aneurysm repair. J Vasc Surg 62, 491498 (2015).
228. de Bruin, J. L. et al. Quality of life from a randomized trial of open and endovascular repair for abdominal aortic aneurysm. Br J Surg 103, 9951002 (2016).
PAGE \* MERGEFORMAT 25
Natzi, you check for you final accept;
accepted most of JPs suggestions;
also moved in smoking and male sex and heredity .
OK ?
Add ref 6.
Add reerence 5 here too? Yes.
From HK
From HK
It would be wrong to say that we identified 9 SNPs. SNPs are the tools (markers) we use to identify genetic loci, regions in the human genome. The genes with functional variants could be far away from these markers. It will require a lot of follow-up work to establish which proteins are involved.
From hk
No, loci. Should we then label the table as genetic loci?
From HK
I did not want to go too deep into the function, since the genetic loci contain many genes and it is not possible to tell at this point which ones harbor functional variants contributing to AAA.
OK
From HK
TAAD field has used mostly different types of genetic analyses so it is not easy to compare.
From HK
Natzi:
Since Natural history is dismantled this section should read Growth and Rupture risk
Actually here we should put back the reference on ASI which is most commonly used:
HYPERLINK "https://www-ncbi-nlm-nih-gov.proxy.kib.ki.se/pubmed/25457240" \o "American journal of surgery."Am J Surg. 2015 Feb;209(2):315-23. doi: 10.1016/j.amjsurg.2014.07.008. Epub 2014 Oct 13.
Impact of gender and body surface area on outcome after abdominal aortic aneurysm repair.
HYPERLINK "https://www-ncbi-nlm-nih-gov.proxy.kib.ki.se/pubmed/?term=Matyal%20R%5BAuthor%5D&cauthor=true&cauthor_uid=25457240"Matyal R1, HYPERLINK "https://www-ncbi-nlm-nih-gov.proxy.kib.ki.se/pubmed/?term=Shakil%20O%5BAuthor%5D&cauthor=true&cauthor_uid=25457240"Shakil O2, HYPERLINK "https://www-ncbi-nlm-nih-gov.proxy.kib.ki.se/pubmed/?term=Hess%20PE%5BAuthor%5D&cauthor=true&cauthor_uid=25457240"Hess PE1, HYPERLINK "https://www-ncbi-nlm-nih-gov.proxy.kib.ki.se/pubmed/?term=Lo%20R%5BAuthor%5D&cauthor=true&cauthor_uid=25457240"Lo R3, HYPERLINK "https://www-ncbi-nlm-nih-gov.proxy.kib.ki.se/pubmed/?term=Jainandunsing%20JS%5BAuthor%5D&cauthor=true&cauthor_uid=25457240"Jainandunsing JS1, HYPERLINK "https://www-ncbi-nlm-nih-gov.proxy.kib.ki.se/pubmed/?term=Mahmood%20B%5BAuthor%5D&cauthor=true&cauthor_uid=25457240"Mahmood B1, HYPERLINK "https://www-ncbi-nlm-nih-gov.proxy.kib.ki.se/pubmed/?term=Hartman%20GS%5BAuthor%5D&cauthor=true&cauthor_uid=25457240"Hartman GS4, HYPERLINK "https://www-ncbi-nlm-nih-gov.proxy.kib.ki.se/pubmed/?term=Schermerhorn%20ML%5BAuthor%5D&cauthor=true&cauthor_uid=25457240"Schermerhorn ML3, HYPERLINK "https://www-ncbi-nlm-nih-gov.proxy.kib.ki.se/pubmed/?term=Mahmood%20F%5BAuthor%5D&cauthor=true&cauthor_uid=25457240"Mahmood F1.
Take away 16.
Guidelines Chaikof,JVS SVS
take away beek, Keeo Lederle,
I think that this needs a reference. New SVS guidelines in JVS 2018?
Parkinson ref or just the SVS guidelines.
Natzi and Lucia: from janet: suggestion to move, maybe here is good ?
Maybe put here instead from below?
JBM wants vSMC
check for standard use of this abbreviation through text
Natzi nd Lucia: from janet:
Given this comment, I wondered whether this section should become H2?
Suggest move up: se text in intro for section.
A new figure 4 on proteases will be added on proteases
Add 6 please, Global.
Possibly we add or exchange Ulug on screening in women with janet powells IN press, Lancet article on women.
this references will be added at the end of the corrections
ADDED ON DEMAND
Need the reference here for IMPROVE
Cite this as: BMJ 2017;359:j4859
This references will be added
Natzi; from Janet;
not certain if we shouldnt just skip this,
It is very rare in clincia practice ?
You decide:
aorto-uni-iliac stent grafts have not completely disappeared
ref Improve three years see above
HYPERLINK "https://www-ncbi-nlm-nih-gov.proxy.kib.ki.se/pubmed/29138135" \o "BMJ (Clinical research ed.)." BMJ. 2017 Nov 14;359:j4859. doi: 10.1136/bmj.j4859.
Comparative clinical effectiveness and cost effectiveness of endovascular strategy v open repair for ruptured abdominal aortic aneurysm: three year results of the IMPROVE randomised trial.
HYPERLINK "https://www-ncbi-nlm-nih-gov.proxy.kib.ki.se/pubmed/?term=IMPROVE%20Trial%20Investigators%5BCorporate%20Author%5D" IMPROVE Trial Investigators.
Natzi: I added this, OK ?
HTMLCONTROL Forms.HTML:Checkbox.1 9.
HYPERLINK "https://www-ncbi-nlm-nih-gov.proxy.kib.ki.se/pubmed/28160528" Meta-analysis of individual-patient data from EVAR-1, DREAM, OVER and ACE trials comparing outcomes of endovascular or open repair for abdominal aortic aneurysm over 5 years.
Powell JT, Sweeting MJ, Ulug P, Blankensteijn JD, Lederle FA, Becquemin JP, Greenhalgh RM; EVAR-1, DREAM, OVER and ACE Trialists.
Br J Surg. 2017 Feb;104(3):166-178. doi: 10.1002/bjs.10430.
PMID:
28160528
HYPERLINK "https://www-ncbi-nlm-nih-gov.proxy.kib.ki.se/pubmed/28160528" Free PMC Article
NATZI ,
OK with these alterations here (merge janet and me ??)
Factual content and grammar corrected
Remove 184-186
Remove 189 and 190
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