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Diabetes & Vascular Disease Research Sep 2016To summarize the association of diabetes with abdominal aortic aneurysm rupture, we reviewed currently available studies with a systematic literature search and... (Meta-Analysis)
Meta-Analysis Review
PURPOSE
To summarize the association of diabetes with abdominal aortic aneurysm rupture, we reviewed currently available studies with a systematic literature search and meta-analytic evaluation.
METHODS
To identify all studies reporting the association of diabetes with abdominal aortic aneurysm rupture, MEDLINE and EMBASE were searched through July 2015. For each study, data regarding diabetes prevalence in both the ruptured and non-ruptured groups were used to generate an unadjusted odds ratio for abdominal aortic aneurysm rupture and 95% confidence intervals. Alternatively, an unadjusted or adjusted odds ratio, or hazard ratio for abdominal aortic aneurysm rupture with 95% confidence interval was directly abstracted (as available) from each individual study.
RESULTS
Our search identified 11 eligible studies. A primary meta-analysis of nine studies reporting data on ruptured (not including non-ruptured symptomatic) abdominal aortic aneurysm demonstrated that diabetes was associated with significantly lower prevalence/incidence of abdominal aortic aneurysm rupture (odds ratio/hazard ratio, 0.71; 95% confidence interval, 0.56 to 0.89; p = 0.003). A secondary meta-analysis of all 11 studies (adding two studies in which non-ruptured symptomatic abdominal aortic aneurysm was included in the rupture group) also demonstrated that diabetes was associated with significantly lower prevalence/incidence of abdominal aortic aneurysm rupture (odds ratio/hazard ratio, 0.77; 95% confidence interval, 0.63 to 0.95; p = 0.01).
CONCLUSION
Diabetes is negatively associated with abdominal aortic aneurysm rupture.
Topics: Aortic Aneurysm, Abdominal; Aortic Rupture; Chi-Square Distribution; Diabetes Mellitus; Humans; Incidence; Odds Ratio; Prevalence; Protective Factors; Risk Assessment; Risk Factors
PubMed: 27334484
DOI: 10.1177/1479164116651389 -
Acta Medica Okayama Dec 2019Abdominal aortic aneurysms (AAAs) usually expand asymptomatically until the occurrence of a life-threatening event such as aortic rupture, which is closely associated... (Review)
Review
Abdominal aortic aneurysms (AAAs) usually expand asymptomatically until the occurrence of a life-threatening event such as aortic rupture, which is closely associated with high mortality. AAA and aortic dissection are ranked among the top 10 causes of death in Japan. The major risk factors for AAA are age over 65 years, male gender, family history, and smoking. Thus, for prevention, smoking cessation is the most important lifestyle-intervention. For treatment, since AAA generally affects elderly people, less invasive treatment is preferable. However, the only established treatment for AAA is open repair and endovascular repair. This review describes potential medical treatments to slow aneurysm growth or prevent AAA rupture.
Topics: Aging; Aortic Aneurysm, Abdominal; Humans
PubMed: 31871328
DOI: 10.18926/AMO/57710 -
The Journal of Thoracic and... Dec 2021Although inguinal hernia and aortic aneurysm share similar pathogenic mechanisms of collagen and elastin destruction, their clinical association in geriatric patients is...
OBJECTIVE
Although inguinal hernia and aortic aneurysm share similar pathogenic mechanisms of collagen and elastin destruction, their clinical association in geriatric patients is inconclusive. We assessed the association between hernia and the subsequent occurrence of aortic aneurysm in geriatric patients.
METHODS
Adult patients with hernias between 2000 and 2012 were identified from a longitudinal claims database of 1 million beneficiaries from Taiwan's National Health Insurance program, and a control group of patients without hernia were matched by propensity score in a ratio of 1:3. Patients previously diagnosed with aortic aneurysms or connective tissue diseases were excluded. Follow-up ended on December 31, 2013. The incidence rate of aortic aneurysm was compared between patients with hernia and those without. Cox proportional hazards models were used to estimate relative hazards.
RESULTS
After propensity score matching, there were 16,933 patients with hernia (aged 20-64 years: 10,326; ≥65 years: 6607) and 50,799 patients without hernia (aged 20-64: 30,978; ≥65: 19,821). Patients with hernia had a greater incidence rate and hazard ratio of aortic aneurysm than did patients without hernia (6.4 vs 4.8/10,000 person-years; adjusted subdistribution hazard ratio [sdHR], 1.34; 95% confidence interval [CI], 1.02-1.76; P = .03), especially for those aged ≥65 years (15.6 vs 10.4/10,000 person-years; adjusted sdHR, 1.44; 95% CI, 1.07-1.94; P = .01) In addition, geriatric patients with hernia were associated with a marginally greater risk of thoracic (adjusted sdHR, 1.66; 95% CI, 0.96-2.86) and abdominal (adjusted sdHR, 1.36; 95% CI, 0.96-1.94) aortic aneurysm rupture.
CONCLUSIONS
Geriatric patients with hernia were associated with a greater incidence of aortic aneurysm than were those without.
Topics: Adult; Age Factors; Aged; Aortic Aneurysm; Female; Hernia, Inguinal; Humans; Incidence; Male; Middle Aged; Retrospective Studies; Young Adult
PubMed: 32222409
DOI: 10.1016/j.jtcvs.2020.01.100 -
Journal of Cardiothoracic and Vascular... Nov 2021The sinuses of Valsalva are outpouchings in the aortic root just distal to the aortic valve that serve several physiologic functions. Aneurysm of this segment of the... (Review)
Review
The sinuses of Valsalva are outpouchings in the aortic root just distal to the aortic valve that serve several physiologic functions. Aneurysm of this segment of the aorta is quite rare and infrequently encountered in clinical practice. Due to the rarity of sinus of Valsalva aneurysms, there is a lack of controlled trials and most of the literature consists of case reports and series. Here, the authors review the currently available literature to discuss the anatomy and normal function of the aortic root, as well as disease pathology and diagnostic imaging considerations. Using reported cases, the authors also will discuss considerations for cardiac anesthesiologists in the perioperative period.
Topics: Aorta; Aortic Aneurysm; Aortic Valve; Humans; Sinus of Valsalva
PubMed: 33431271
DOI: 10.1053/j.jvca.2020.12.016 -
Interactive Cardiovascular and Thoracic... Jan 2022The aim of this study was to report the outcomes of open or hybrid repair of failed thoraco-abdominal aortic aneurysm endovascular treatment with Multilayer Flow...
OBJECTIVES
The aim of this study was to report the outcomes of open or hybrid repair of failed thoraco-abdominal aortic aneurysm endovascular treatment with Multilayer Flow Modulator (MFM) stents.
METHODS
All patients who underwent open or hybrid repair of a failed MFM aortic treatment were retrospectively analysed. Perioperative and postoperative data, as well as midterm survival, were assessed.
RESULTS
Between 2013 and 2020, 39 patients received an open or hybrid conversion after endovascular treatment. Five of them [13%; 4 males; median age 68 years (interquartile range 66-76)] were previously treated with aortic MFM stents (Cardiatis, Isnes, Belgium). Among these, the median interval between index repair and conversion was 84 months (interquartile range 75-84). The median aneurysm diameter was 9.6 cm (interquartile range 8-10). Renovisceral vessels steno-occlusion was highly prevalent: 2 renal arteries were occluded; 3 coeliac trunks, 2 renal arteries and 1 superior mesenteric artery had a >70% ostial stenosis. Open standard thoraco-abdominal aneurysm conversion was performed in 3 fit patients, while a hybrid approach with visceral debranching and tube endografting was performed in 2 high-risk patients. Two patients (2 open repairs) died intraoperatively, and 1 (hybrid repair) postoperatively. The 2 successfully treated patients are alive at 4- and 34-month follow-up, respectively, with patent visceral branches.
CONCLUSIONS
Open or hybrid thoraco-abdominal aortic aneurysm treatment after failed endovascular aortic repair with MFM stents might be the only surgical option to address sac enlargements and ruptures or branch-related failures. However, both procedures had a poor prognosis due to both the impaired preoperative patient's status and the surgical complexity in the presented series.
Topics: Aged; Aortic Aneurysm, Abdominal; Aortic Aneurysm, Thoracic; Blood Vessel Prosthesis; Blood Vessel Prosthesis Implantation; Endovascular Procedures; Humans; Male; Prosthesis Design; Retrospective Studies; Stents; Treatment Outcome; Vascular Patency
PubMed: 34999791
DOI: 10.1093/icvts/ivab224 -
The Journal of Thoracic and... Apr 2017
Topics: Aortic Aneurysm; Aortic Aneurysm, Thoracic; Echocardiography; Echocardiography, Transesophageal; Humans
PubMed: 28065433
DOI: 10.1016/j.jtcvs.2016.11.050 -
Journal of Vascular Surgery May 2022The current guidelines have recommended repair of abdominal aortic aneurysms (AAAs) according to the maximal AAA diameter and/or its growth rate. However, many studies...
BACKGROUND
The current guidelines have recommended repair of abdominal aortic aneurysms (AAAs) according to the maximal AAA diameter and/or its growth rate. However, many studies have suggested that the AAA diameter alone is not sufficient to predict the risk of rupture or symptomatic presentation. Several investigators have attempted to relate the AAA diameter to the body surface area in predicting for rupture. However, these calculations have not resulted in conclusive evidence. We sought in the present analysis to introduce a novel diameter-to-height index (DHI) and test its utility in predicting for symptomatic presentations, including rupture and 30-day and 5-year mortality.
METHODS
The Vascular Quality Initiative database (2003-2020) was used to identify patients who had undergone open or endovascular AAA repair. The DHI was defined as the AAA diameter in centimeters divided by the height in centimeters, yielding a score of 1 to 10. Multivariable logistic regression analysis was performed to assess the risk of symptomatic presentation, including rupture and 30-day mortality. Receiver operating characteristic curves were plotted, and survival analysis techniques were used to determine the hazard of 5-year mortality.
RESULTS
A total of 64,595 patients were identified, of whom, 16.3% had presented with symptomatic AAAs, including rupture. Endovascular AAA repair was performed for 69.8% of the symptomatic AAAs and 84.3% of asymptomatic AAAs (P < .001). The symptomatic group were more likely to be women (24.6% vs 19.8%; P < .001) and Black (7.81% vs 4.44%; P < .001). The mean DHI was higher in the symptomatic group than in the asymptomatic group (mean DHI, 3.92 ± 1.1 vs 3.24 ± 0.7; P < .001). The adjusted odds of a symptomatic presentation increased with an increasing DHI (adjusted odds ratio [aOR], 1.70; 95% confidence interval [CI], 1.59-1.83; P < .001). Active smoking increased the risk of a symptomatic presentation (aOR, 1.38; 95% CI, 1.28-1.51; P < .001). However, the use of preoperative statins and beta-blockers significantly reduced the odds of a symptomatic presentation (aOR, 0.58; 95% CI, 0.53-0.64; P < .001; and aOR, 0.76; 95% CI, 0.69-0.84; P < .001), respectively. Compared with the AAA diameter, the receiver operating characteristic curve for the DHI to predict for symptomatic status was slightly, but significantly, higher (aOR, 0.702; 95% CI, 0.695-0.708; vs aOR, 0.695; 95% CI, 0.688-0.701; P < .001). The DHI increment was associated with a 1.08 greater odds of 30-day mortality (aOR, 1.08; 95% CI, 1.01-1.15; P < .001) for those with symptomatic AAAs. Similarly, the hazard of 5-year mortality was increased with an increasing DHI (adjusted hazard ratio, 1.20; 95% CI, 1.13-1.29; P < .001) only for those with asymptomatic AAAs.
CONCLUSIONS
The DHI is a simple tool that could be more effective than the AAA diameter in predicting for symptomatic presentations. The DHI varied by sex and race, which could collectively help to provide an individualized prognosis. The DHI can additionally predict the 5-year mortality after AAA repair for those with asymptomatic AAAs only. However, the odds of 30-day mortality remained similar in both groups.
Topics: Aortic Aneurysm, Abdominal; Aortic Rupture; Blood Vessel Prosthesis Implantation; Endovascular Procedures; Female; Humans; Male; Retrospective Studies; Risk Factors; Time Factors; Treatment Outcome
PubMed: 34793921
DOI: 10.1016/j.jvs.2021.10.055 -
Seminars in Thoracic and Cardiovascular... 2023The aim of this study was to improve insight into male-female differences in patients undergoing ascending aortic aneurysm surgery. Consecutive patients that underwent...
The aim of this study was to improve insight into male-female differences in patients undergoing ascending aortic aneurysm surgery. Consecutive patients that underwent ascending aortic aneurysm surgery between January 1991-December 2016 were retrospectively analyzed. Patient and procedural characteristics, 30-day mortality, and survival were compared between male and female patients. Multivariable Cox-regression analysis was performed to explore differences in factors associated with long-term mortality. Of 631 included patients, 36% were female patients. They were older (66 (55.9-72.9) vs 56 (44.1-67.3) years, p < 0.001), had a higher logistic EuroSCORE (12 (8-17) vs 8 (5-12), p < 0.001), and underwent concomitant arch surgery more often (74% vs 54%, p < 0.001). Aortic diameter (5.5 (5.0.6.5) vs 5.5 (5.0-6.0) cm, p = 0.025) and Aortic Size Index (3.15 (2.80-3.65) vs 2.70 (2.42-3.00) cm/m, p < 0.001) were larger in female patients. Early mortality was 0.9% in female patients and 2.0% in male patients (p = 0.51). Adjusted 15-year survival was comparable between male and female patients. Multivariable Cox-regression did not identify an independent association between female sex and mortality. In males a larger aortic diameter (HR1.38 per centimeter increase, 95%-CI 1.03-1.85, p = 0.003) was an independent factor associated with mortality, and in female patients a larger BSA (HR0.08 per 1kg/m increase, 95%-CI 0.01-0.49, p = 0.007) was an independent risk-reducing factor. Female patients presented at older age and with more advanced disease. Increased awareness for ascending aortic pathology and timely referral may result in better preoperative profiles in female patients. This may improve outcomes after ascending aortic aneurysm surgery.
Topics: Humans; Male; Female; Retrospective Studies; Aneurysm, Ascending Aorta; Treatment Outcome; Aortic Aneurysm; Aorta; Risk Factors
PubMed: 35093534
DOI: 10.1053/j.semtcvs.2022.01.002 -
The Journal of Thoracic and... Oct 2020
Topics: Aorta; Aortic Aneurysm, Abdominal; Aortic Aneurysm, Thoracic; Blood Vessel Prosthesis Implantation; Humans
PubMed: 31606171
DOI: 10.1016/j.jtcvs.2019.08.073 -
Journal of Vascular Surgery Jun 2023To compare the risk of mortality and complications between male and female patients undergoing aortic aneurysm repair with fenestrated-branched endovascular aortic... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
To compare the risk of mortality and complications between male and female patients undergoing aortic aneurysm repair with fenestrated-branched endovascular aortic repair (FBEVAR).
METHODS
The PubMed, Embase, and Scopus databases were searched systematically for observational studies in patients undergoing elective fenestrated branched endovascular repair for aortic aneurysm. The included studies compared outcomes of interest based on the sex of the patients. The pooled effect sizes were reported as odds ratio (OR) and weighted mean difference (WMD). STATA software was used for statistical analysis.
RESULTS
The meta-analysis included nine studies. Compared with males, females had a higher risk of perioperative and in-hospital mortality (OR, 3.01; 95% confidence interval [CI], 2.01-4.53), mortality within 1 year postoperatively (OR, 1.79; 95% CI, 1.09-2.93) and mortality at more than 1 year postoperatively (OR, 1.31l 95% CI, 1.02-1.69). Female patients had significantly higher operative time (minutes) (WMD, 33.77; 95% CI, 12.01-55.52), length of hospital stay (days) (WMD, 2.29; 95% CI, 1.52-3.07), and the risk of major complications (OR, 2.93; 95% CI, 1.36-6.32) There was an increased risk of respiratory complications (OR, 1.70; 95% CI, 1.20-2.40), renal complications (OR, 2.68; 95% CI, 1.25-5.74), stroke (OR, 2.74; 95% CI, 1.44-5.22), sepsis (OR, 2.24; 95% CI, 1.23-4.09), and ischemic colitis (OR, 2.63; 95% CI, 1.48-4.68) in female patients, and they were less likely to be discharged home postoperatively (OR, 0.58; 95% CI, 0.43-0.77).
CONCLUSIONS
In patients undergoing FBEVAR, female sex is associated with higher risk of mortality and complications. These findings suggest the need for careful supervision and management by multidisciplinary team in females undergoing FBEVAR.
Topics: Humans; Male; Female; Blood Vessel Prosthesis; Aortic Aneurysm, Thoracic; Blood Vessel Prosthesis Implantation; Endovascular Procedures; Treatment Outcome; Postoperative Complications; Risk Factors; Aortic Aneurysm; Aortic Aneurysm, Abdominal
PubMed: 37232176
DOI: 10.1016/j.jvs.2022.10.029