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Biomedicines Mar 2023Recently, AAA volume measurement has been proposed as a potentially valuable surveillance method in situations when diameter measurement might fail. (Review)
Review
UNLABELLED
Recently, AAA volume measurement has been proposed as a potentially valuable surveillance method in situations when diameter measurement might fail.
OBJECTIVE
The aim of this systematic review was to analyze the results of previous studies comparing AAA diameter and volume measurements.
METHODS
A systematic search in PubMed, Cochrane, and EMBASE databases was performed to identify studies investigating the use of diameter and volume measurements in AAA diagnosis and prognosis in English, German, and Russian, published until December 2022. The manuscripts were reviewed by three researchers and scored on the quality of the research using MINORS criteria.
RESULTS
After screening 752 manuscripts, 19 studies ( = 1690) were included. The majority ( = 17) of the manuscripts appeared to favor volume. It is, however, important to highlight the heterogeneity of methodologies and lack of standardized protocol for measuring both volume and diameter in the included studies, which hindered the interpretation of the results.
CONCLUSIONS
The clinical relevance of abdominal aortic aneurysm volume measurement is still unclear, although studies show favorable and promising results for volumetric changes in AAA, especially in follow-up after EVAR.
PubMed: 36979920
DOI: 10.3390/biomedicines11030941 -
European Journal of Vascular and... Nov 2022The role of antithrombotic therapy in the management of aortic and peripheral aneurysms is unclear. This systematic review and meta-analysis aimed to assess the impact... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVES
The role of antithrombotic therapy in the management of aortic and peripheral aneurysms is unclear. This systematic review and meta-analysis aimed to assess the impact of antithrombotics on clinical outcomes for aortic and peripheral aneurysms.
METHODS
Medline, Embase, and CENTRAL databases were searched. Randomised controlled trials and observational studies investigating the effect of antithrombotic therapy on clinical outcomes for patients with any aortic or peripheral artery aneurysm were included.
RESULTS
Fifty-nine studies (28 with antiplatelet agents, 12 anticoagulants, two intra-operative heparin, and 16 any antithrombotic agent) involving 122 102 patients were included. Abdominal aortic aneurysm (AAA) growth rate was not significantly associated with the use of antiplatelet therapy (SMD -0.36 mm/year; 95% CI -0.75 - 0.02; p = .060; GRADE certainty: very low). Antithrombotics were associated with increased 30 day mortality for patients with AAAs undergoing intervention (OR 2.30; 95% CI 1.51 - 3.51; p < .001; GRADE certainty: low). Following intervention, antiplatelet therapy was associated with reduced long term all cause mortality (HR 0.84; 95% CI 0.76 - 0.92; p < .001; GRADE certainty: moderate), whilst anticoagulants were associated with increased all cause mortality (HR 1.64; 95% CI 1.14 - 2.37; p = .008; GRADE certainty: very low), endoleak within three years (OR 1.99; 95% CI 1.10 - 3.60; p = .020; I = 60%; GRADE certainty: very low), and an increased re-intervention rate at one year (OR 3.25; 95% CI 1.82 - 5.82; p < .001; I = 35%; GRADE certainty: moderate). Five studies examined antithrombotic therapy for popliteal aneurysms. Meta-analysis was not possible due to heterogeneity.
CONCLUSIONS
There was a lack of high quality data examining antithrombotic therapy for patients with aneurysms. Antiplatelet therapy was associated with a reduction in post-intervention all cause mortality for AAA, whilst anticoagulants were associated with an increased risk of all cause mortality, endoleak, and re-intervention. Large, well designed trials are still required to determine the therapeutic benefits of antithrombotic agents in this setting.
Topics: Humans; Fibrinolytic Agents; Platelet Aggregation Inhibitors; Endoleak; Aortic Aneurysm, Abdominal; Anticoagulants
PubMed: 35853579
DOI: 10.1016/j.ejvs.2022.07.008 -
Current Cardiology Reviews 2021Aortic aneurysms are worrisome because of their predisposition to dissection and rupture. Beta-blockers are considered first-line therapy for aortic aneurysms. The... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Aortic aneurysms are worrisome because of their predisposition to dissection and rupture. Beta-blockers are considered first-line therapy for aortic aneurysms. The following meta-analysis assesses if beta-blockers diminish aortic aneurysm growth.
METHODS
A literature search was performed to collect information on clinical trials that have assessed aortic aneurysm growth between beta-blockers and placebo. The primary endpoint was aortic aneurysm growth rate per year. A forest plot with a random-effects model was used for analysis.
RESULTS
Eight clinical trials were included in the analysis. Beta-blockers showed a statistically non-significant effect on aortic aneurysm growth (standard mean difference -0.44; 95% CI [-0.44, 0.00]).
CONCLUSION
Beta-blockers do not significantly influence aortic aneurysm growth. Further studies are required to find a suitable medical therapy to reduce growth rates.
Topics: Adrenergic beta-Antagonists; Aortic Aneurysm, Abdominal; Humans
PubMed: 33143615
DOI: 10.2174/1573403X16999201102213619 -
WMJ : Official Publication of the State... Sep 2020Recent studies have raised concerns that fluoroquinolone use is associated with an increased risk of aortopathy, including aortic aneurysm with and without dissection. (Meta-Analysis)
Meta-Analysis Review
INTRODUCTION
Recent studies have raised concerns that fluoroquinolone use is associated with an increased risk of aortopathy, including aortic aneurysm with and without dissection.
OBJECTIVE
We performed a meta-analysis with a comprehensive literature review to further investigate this association.
METHODS
This analysis was conducted per PRISMA guidelines. PubMed, Cochrane Library, ClinicalTrials.gov, Embase, Web of Science, and Google Scholar were searched for studies that included adult patients (age >18 years) exposed to fluoroquinolones or control antibiotics (amoxicillin/any other antibiotic) for urinary tract infection or pneumonia with a primary outcome of aortic aneurysm or dissection. Heterogeneity was calculated using Q statistic I.
RESULTS
A total of 6 studies-comprised of 59% males-were included in our analysis, which showed an increased combined risk of development of aortic aneurysm and aortic dissection with quinolone exposure when compared with controls (relative risk [RR] = 2.11; 95% CI, 1.62 - 2.75; I= 83.700). Individual relative risk for aortic aneurysm (RR = 2.83; 95% CI, 2.02 - 3.95, I = 89.150) and aortic dissection (RR = 1.99; 95% CI, 1.23 - 3.06; I2= 71.33) also were significantly increased.
CONCLUSION
Compared to other antibiotics, the use of fluoroquinolones was associated with a significantly higher risk of aortic aneurysm and dissection combined.
Topics: Adolescent; Adult; Aortic Dissection; Anti-Bacterial Agents; Aortic Aneurysm; Female; Fluoroquinolones; Humans; Male
PubMed: 33091293
DOI: No ID Found -
Frontiers in Cardiovascular Medicine 2022To systematically examine the association between metformin and abdominal aortic aneurysm (AAA) and provide a basis for the treatment of AAA.
OBJECTIVE
To systematically examine the association between metformin and abdominal aortic aneurysm (AAA) and provide a basis for the treatment of AAA.
METHODS
Pubmed, Embase, Cochrane Library, and Ovid databases were searched by computer to identify the literature related to metformin and AAA published until February 2022. The literature was screened according to the inclusion and exclusion criteria, data were extracted, and a quality assessment was conducted. The meta-analysis was performed using Stata 16.0 and RevMan 5.3 software.
RESULTS
Seven articles containing a total of 10 cohort studies (85,050 patients) met the inclusion criteria and were included in the review. Meta-analysis showed that metformin can limit the expansion of AAA (MD = - 0.72, 95% CI: - 1.08 ~ -0.37, < 0.00001), as well as reduce AAA repair or AAA rupture-related mortality (OR = 0.80, 95% CI:0.66 ~ 0.96, = 0.02). The difference was statistically significant ( < 0.05).
CONCLUSION
Metformin can limit the expansion of AAA and reduce the incidence of AAA and postoperative mortality. However, further biological experiments and clinical trials still need to be conducted to support this.
PubMed: 35677692
DOI: 10.3389/fcvm.2022.908747 -
Brain Sciences Feb 2020Most available large animal extracranial aneurysm models feature healthy non-degenerated aneurysm pouches with stable long-term follow-ups and extensive healing... (Review)
Review
BACKGROUND
Most available large animal extracranial aneurysm models feature healthy non-degenerated aneurysm pouches with stable long-term follow-ups and extensive healing reactions after endovascular treatment. This review focuses on a small subgroup of extracranial aneurysm models that demonstrated growth and potential rupture during follow-up.
METHODS
The literature was searched in Medline/Pubmed to identify extracranial in vivo saccular aneurysm models featuring growth and rupture, using a predefined search strategy in accordance with the PRISMA guidelines. From eligible studies we extracted the following details: technique and location of aneurysm creation, aneurysm pouch characteristics, time for model creation, growth and rupture rate, time course, patency rate, histological findings, and associated morbidity and mortality.
RESULTS
A total of 20 articles were found to describe growth and/or rupture of an experimentally created extracranial saccular aneurysm during follow-up. Most frequent growth was reported in rats ( = 6), followed by rabbits ( = 4), dogs ( = 4), swine ( = 5), and sheep ( = 1). Except for two studies reporting growth and rupture within the abdominal cavity (abdominal aortic artery; = 2) all other aneurysms were located at the neck of the animal. The largest growth rate, with an up to 10-fold size increase, was found in a rat abdominal aortic sidewall aneurysm model.
CONCLUSIONS
Extracranial saccular aneurysm models with growth and rupture are rare. Degradation of the created aneurysmal outpouch seems to be a prerequisite to allow growth, which may ultimately lead to rupture. Since it has been shown that the aneurysm wall is important for healing after endovascular therapy, it is likely that models featuring growth and rupture will gain in interest for preclinical testing of novel endovascular therapies.
PubMed: 32069946
DOI: 10.3390/brainsci10020101 -
Heart (British Cardiac Society) Sep 2019To assess the association of metformin prescription with the risk of aortic aneurysm, aortic aneurysm events and the enlargement of abdominal aortic aneurysm (AAA). (Meta-Analysis)
Meta-Analysis
OBJECTIVE
To assess the association of metformin prescription with the risk of aortic aneurysm, aortic aneurysm events and the enlargement of abdominal aortic aneurysm (AAA).
DESIGN
Systematic review and meta-analysis.
METHODS
We searched PubMed, Embase and Scopus for epidemiological studies up to November 2018. We included observational studies which evaluated the association of metformin prescription with the risk of aortic aneurysm disease, and we also included studies involving progression and enlargement of AAA. The Newcastle-Ottawa Scale was used to assess the quality of included studies. Random-effect meta-analyses were conducted in line with the between-study heterogeneity. Sensitivity analyses were performed to identify the source of heterogeneity.
RESULTS
Eight studies enrolling 29 587 participants met the inclusion criteria and were included in this systematic review. We found that metformin prescription could significantly limit the enlargement of aortic aneurysm (weighted mean difference: -0.83 mm/year, 95% CI -1.38 to -0.28, I=89.6%) among patients with AAA. Metformin prescription status may be associated with a decreased risk of aortic aneurysm and aortic aneurysm events.
CONCLUSIONS
According to the available epidemiological evidence, metformin prescription could limit the expansion of AAA among patients with this disease, and may be involved with a lower incidence of aortic aneurysm and aortic aneurysm events. Randomised controlled trials are needed to confirm whether metformin could reduce the enlargement of AAA in patients with or without diabetes.
Topics: Aortic Aneurysm, Abdominal; Aortic Rupture; Diabetes Mellitus; Disease Progression; Drug Prescriptions; Drug Utilization; Humans; Hypoglycemic Agents; Incidence; Metformin; Practice Patterns, Physicians'; Risk Assessment; Risk Factors
PubMed: 30936409
DOI: 10.1136/heartjnl-2018-314639 -
Annals of Vascular Surgery Oct 2021The aim of this study is to assess any relation between spondylitis and aortic aneurysmal disease by reviewing the current literature.
OBJECTIVES
The aim of this study is to assess any relation between spondylitis and aortic aneurysmal disease by reviewing the current literature.
METHODS
A systematic search was undertaken using MEDLINE, EMBASE and CENTRAL databases till May 2019, for articles reporting on patients suffering from spondylitis and aortic aneurysm.
RESULTS
The most involved aortic segment was infrarenal aorta (56.9%). The lumbar vertebrae were more frequently affected (79.7%). Commonest symptoms were back pain (79.1%), fever (33.7%) and lower limb pain (29.1%). 55.8% of cases were diagnosed using computed tomography. The pathology was attributed to infectious causes in 25.1% of cases. 53.4% of patients were treated only for the aneurysm, 27.9% for both pathologies, while two patients solely for the vertebral disease. Endovascular aneurysm repair was chosen in 12.8% of cases. The 30-day mortality was 8.1% (7/86); mostly from vascular complications.
CONCLUSIONS
A synchronous spondylitis and aortic aneurysm may share common etiopathology, when an infectious or inflammatory cause is presented. The lumbar vertebrae are more frequently affected. Low quality data do not allow safe conclusion to suggest the best treatment option.
Topics: Adult; Aged; Aged, 80 and over; Aneurysm, Infected; Aortic Aneurysm, Abdominal; Blood Vessel Prosthesis Implantation; Bone Transplantation; Conservative Treatment; Endovascular Procedures; Female; Humans; Lumbar Vertebrae; Male; Middle Aged; Osteotomy; Risk Assessment; Risk Factors; Spondylitis; Time Factors; Treatment Outcome; Young Adult
PubMed: 33951524
DOI: 10.1016/j.avsg.2021.04.020 -
Acta Ophthalmologica Aug 2023Several studies have suggested a possible relationship between exfoliation syndrome (XFS) and abdominal aortic aneurysm (AAA). A systematic literature review was... (Review)
Review
Several studies have suggested a possible relationship between exfoliation syndrome (XFS) and abdominal aortic aneurysm (AAA). A systematic literature review was undertaken to investigate this potential association. The systematic literature review was performed according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Clear definitions of XFS and AAA were used to identify eligible studies via an unrestricted search of the PubMed interface from 1979 to October 31st, 2021. After review, 876 citations were gathered and evaluated for inclusion, from which 22 articles were included. Of these 22, 16 were excluded because they did not assess the relationship between AAA and XFS or provide primary data. Ultimately, six studies were included in this literature review. Half of the studies explored AAA prevalence in a population with or without XFS, and the other half explored the opposite. Three studies supported XFS as a risk factor for the development of AAA, and the other three found this relationship to be inconclusive. This systematic review revealed inconsistent results regarding an association between AAA and XFS. A large database study including XFS and AAA patients would be useful in further determining if an association does in fact exist.
Topics: Humans; Exfoliation Syndrome; Risk Factors; Aortic Aneurysm, Abdominal; Prevalence
PubMed: 36482872
DOI: 10.1111/aos.15307 -
ANZ Journal of Surgery Sep 20213D printed (3DP) abdominal aortic aneurysm (AAA) phantoms are emerging in the literature as an adjunct for the visualization of complex anatomy, particularly for... (Review)
Review
BACKGROUND
3D printed (3DP) abdominal aortic aneurysm (AAA) phantoms are emerging in the literature as an adjunct for the visualization of complex anatomy, particularly for presurgical device selection and simulation. This is the first systematic review to provide a comprehensive overview of 3DP for endovascular aneurysm repair (EVAR) planning and intervention, evaluating the readiness of current levels of technology for mainstream implementation.
METHODS
A systematic literature search of PubMed and MEDLINE was performed as per PRISMA guidelines using the terms '3D Printing', 'AAA' OR 'EVAR' and related index terms, and further relevant articles were appraised via a snowballing approach. Our last search was conducted on 14 November 2020.
RESULTS
Twenty-five articles were identified for critical analysis, with 14 cases or technical reports. Nineteen publications utilized 3DP AAA phantoms to aid presurgical decision making, device selection and design. Four publications explored the utility of 3DP phantoms as EVAR trainers, and one publication examined the technology as a tool for patient education. Flexible, transparent phantoms were deemed most useful; however, the cost and availability of higher end machines limited accessibility.
CONCLUSION
3DP phantoms have been used in EVAR to facilitate visualization of complex patient anatomy, appropriate device selection, in predicting navigational difficulties and the shape and position of endograft after deployment. These phantoms show promise in reducing known complications such as endoleak, stent graft occlusion and migration; however, larger scale prospective studies are required to validate its impacts on patient outcomes and cost savings to the healthcare system.
Topics: Aortic Aneurysm, Abdominal; Blood Vessel Prosthesis; Blood Vessel Prosthesis Implantation; Endovascular Procedures; Humans; Printing, Three-Dimensional; Prosthesis Design; Risk Factors; Stents; Treatment Outcome
PubMed: 33825293
DOI: 10.1111/ans.16763