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Anesthesiology Clinics Dec 2022Abdominal aortic aneurysm is a potentially lethal condition that is decreasing in frequency as tobacco use declines. The exact etiology remains unknown, but smoking and... (Review)
Review
Abdominal aortic aneurysm is a potentially lethal condition that is decreasing in frequency as tobacco use declines. The exact etiology remains unknown, but smoking and other perturbations seem to trigger an inflammatory state in the tunica media. Male sex and advanced age are clear demographic risk factors for the development of abdominal aortic aneurysms. The natural history of this disease varies, but screening remains vital as it is rarely diagnosed on physical examination, and elective repair (most commonly done endovascularly) offers significant morbidity and mortality advantages over emergent intervention for aortic rupture.
Topics: Male; Humans; Aortic Aneurysm, Abdominal; Aortic Rupture; Elective Surgical Procedures; Risk Factors; Mass Screening
PubMed: 36328621
DOI: 10.1016/j.anclin.2022.08.010 -
Annals of Vascular Surgery Aug 2023Acute type B aortic dissection (TBAD) is a rare disease that is likely under-diagnosed in the UK. As a progressive, dynamic clinical entity, many patients initially... (Review)
Review
BACKGROUND
Acute type B aortic dissection (TBAD) is a rare disease that is likely under-diagnosed in the UK. As a progressive, dynamic clinical entity, many patients initially diagnosed with uncomplicated TBAD deteriorate, developing end-organ malperfusion and aortic rupture (complicated TBAD). An evaluation of the binary approach to the diagnosis and categorisation of TBAD is needed.
METHODS
A narrative review of the risk factors predisposing patients to progression from unTBAD to coTBAD was undertaken.
RESULTS
Key high-risk features predispose the development of complicated TBAD, such as maximal aortic diameter > 40 mm and partial false lumen thrombosis.
CONCLUSION
An appreciation of the factors that predispose to complicated TBAD would aid clinical decision-making surrounding TBAD.
Topics: Humans; Treatment Outcome; Endovascular Procedures; Retrospective Studies; Aortic Dissection; Aortic Rupture; Risk Factors; Aortic Aneurysm, Thoracic; Blood Vessel Prosthesis Implantation
PubMed: 37075834
DOI: 10.1016/j.avsg.2023.04.006 -
Radiology Sep 2022
Topics: Aortic Aneurysm, Abdominal; Aortic Rupture; Elasticity Imaging Techniques; Humans; Risk Factors
PubMed: 35638930
DOI: 10.1148/radiol.221044 -
Giornale Italiano Di Cardiologia (2006) Nov 2020Aortic annulus rupture is a dangerous complication of transcatheter aortic valve implantation, with an overall incidence of around 1%. Ruptures can be distinguished into...
Aortic annulus rupture is a dangerous complication of transcatheter aortic valve implantation, with an overall incidence of around 1%. Ruptures can be distinguished into supra-annular, involving injuries of the sinus of Valsalva and the sinotubular junction, annular, involving the fibrous portion of the aortic annulus, and sub-annular, located in the left ventricular outflow tract below the aortic valve cusp insertion. Annular rupture can be "contained", which usually evolves in aortic hematoma or pseudoaneurysm and rarely requires emergent cardiac surgery; or "non-contained", acutely evolving in hemopericardium with cardiac tamponade, often requiring emergent cardiac surgery and with an in-hospital mortality of 75%. Balloon-expandable oversizing and severe left ventricular outflow tract calcifications, especially under the left coronary cusp, are the most important risk factors for annular rupture. A careful computed tomography scan-based procedural planning is of paramount importance to reduce the risk of this complication. The presence and extension of left ventricular outflow tract calcifications, together with precise measurement of the virtual basal ring, should drive the operator to the right choice of prosthesis type and size in order to prevent this terrible complication.
Topics: Aortic Rupture; Aortic Valve; Aortic Valve Stenosis; Calcinosis; Heart Valve Prosthesis; Heart Valve Prosthesis Implantation; Humans; Prosthesis Design; Transcatheter Aortic Valve Replacement; Treatment Outcome
PubMed: 33295330
DOI: 10.1714/3487.34668 -
Journal of Vascular Surgery Nov 2022The maximal aortic diameter has been used as a key indication for whether to repair abdominal aortic aneurysms (AAAs). Aortic tortuosity has been proposed as another...
OBJECTIVE
The maximal aortic diameter has been used as a key indication for whether to repair abdominal aortic aneurysms (AAAs). Aortic tortuosity has been proposed as another factor to consider. In the present study, we compared the degree of aortic tortuosity in ruptured AAAs with that of unruptured AAAs using computed tomography.
METHODS
We performed a retrospective review of a prospectively maintained database of patients who had undergone AAA repair from December 2014 to December 2019. Patients with a ruptured aneurysm (rAAA) were matched with patients with a nonruptured AAA (nrAAA) with the same maximal aneurysm diameter and age. The degree of aortic tortuosity, defined as the maximum lateral deviation from the aortic centerline, was measured on preoperative coronal computed tomography scans.
RESULTS
During a 5-year period, 572 AAA cases were identified. The aortic tortuosity of the 25 rAAA cases was compared with that of a matched control group of 31 nrAAAs, selected by the same mean maximum diameter of 8.4 cm and similar patient age. In the rAAA group, the mean age was 74.8 years (84% men). In the nrAAA group, the mean age was 76.3 years (88% men). The mean aortic tortuosity for the rAAA and nrAAA groups was 9.3 ± 7.9 mm and 18.0 ± 11.2 mm, respectively (P < .01).
CONCLUSIONS
Greater aortic tortuosity was seen in the nrAAA cases compared with the rAAA cases at the same matched aneurysm size. Thus, aortic tortuosity might confer a reduced rupture risk. Further studies with larger cohorts are needed to verify this observation.
Topics: Male; Humans; Aged; Female; Aortic Aneurysm, Abdominal; Risk Factors; Aortic Rupture; Tomography, X-Ray Computed; Aorta; Retrospective Studies
PubMed: 35489553
DOI: 10.1016/j.jvs.2022.03.879 -
Trends in Cardiovascular Medicine Nov 2020The proper management of small abdominal aortic aneurysms (AAAs), namely those under the threshold of 5.5 cm in diameter, has been under investigation for years. Risk... (Review)
Review
The proper management of small abdominal aortic aneurysms (AAAs), namely those under the threshold of 5.5 cm in diameter, has been under investigation for years. Risk of rupture for this group of AAAs is higher than the general population, although it remains low enough not to require a repair. However, specific factors have been associated with increased expansion or rupture rate, and these factors could identify potential candidates for earlier intervention. This review aims to collect and present all available data on the development and progress of small AAAs. Moreover, recommendations on proper management are discussed as well.
Topics: Aortic Aneurysm, Abdominal; Aortic Rupture; Clinical Decision-Making; Disease Progression; Humans; Practice Guidelines as Topic; Prognosis; Randomized Controlled Trials as Topic; Risk Assessment; Risk Factors; Time Factors
PubMed: 31796345
DOI: 10.1016/j.tcm.2019.11.006 -
European Journal of Vascular and... May 2022Brucellosis is the most common zoonosis worldwide. Although cardiovascular complications in human brucellosis comprise only 3% of morbidity, they are the principal cause... (Review)
Review
OBJECTIVE
Brucellosis is the most common zoonosis worldwide. Although cardiovascular complications in human brucellosis comprise only 3% of morbidity, they are the principal cause of death. Endocarditis covers the majority of these cases. Infected aneurysms and ulcerative processes of the aorta are rare but can be life threatening as well. Currently, limited information is available about aortic and iliac involvement in brucellosis.
METHODS
A PubMed, Web of Science, and AccessMedicine search (without restriction on language or year of publication) was performed to identify relevant articles on aortic and iliac involvement in brucellosis. Case reports were eligible for inclusion if they reported on thoracic, abdominal, or iliac aortic pathology caused by Brucella.
RESULTS
Seventy-one cases were identified over the last 70 years, with an overall mortality rate of 22%. Most of the patients were male (86%) and had a history of Brucella exposure (66%). Approximately one quarter (23%) contracted Brucella while travelling in a (hyper)endemic region. Almost half of the infections were located in the abdominal aorta (49%), followed by the ascending (37%) and descending (13%) thoracic aorta. Infected aneurysms (61%) and ulcerative processes (16%) were seen most frequently. Aortic rupture was present in 31% of cases and occurred mainly in the abdominal (49%) and descending thoracic aorta (44%). The majority of all patients (59%) underwent open surgery combined with long term antibiotics. Over the past 15 years, a trend towards endovascular treatment was observed.
CONCLUSION
Although aortic and iliac involvement in brucellosis is rare, it can be a life threatening manifestation. Due to low awareness, this infection may represent an under reported disease. The therapeutic cornerstone in these cases remains open surgery combined with antibiotics. The role of endovascular treatment is yet to be decided, in which the condition of the patient and the risks of long term complications need to be considered.
Topics: Aneurysm, Infected; Anti-Bacterial Agents; Aorta, Abdominal; Aortic Rupture; Brucellosis; Female; Humans; Male
PubMed: 35282998
DOI: 10.1016/j.ejvs.2022.02.004 -
Journal of Vascular Surgery Jan 2023At present, the rupture risk prediction of abdominal aortic aneurysms (AAAs) and, hence, the clinical decision making regarding the need for surgery, is determined by... (Review)
Review
OBJECTIVE
At present, the rupture risk prediction of abdominal aortic aneurysms (AAAs) and, hence, the clinical decision making regarding the need for surgery, is determined by the AAA diameter and growth rate. However, these measures provide limited predictive information. In the present study, we have summarized the measures of local vascular characteristics of the aneurysm wall that, independently of AAA size, could predict for AAA progression and rupture.
METHODS
We systematically searched PubMed and Web of Science up to September 13, 2021 to identify relevant studies investigating the relationship between local vascular characteristics of the aneurysm wall and AAA growth or rupture in humans. A quality assessment was performed using the ROBINS-I (risk of bias in nonrandomized studies of interventions) tool. All included studies were divided by four types of measures of arterial wall characteristics: metabolism, calcification, intraluminal thrombus, and compliance.
RESULTS
A total of 20 studies were included. Metabolism of the aneurysm wall, especially when measured by ultra-small superparamagnetic iron oxide uptake, and calcification were significantly related to AAA growth. A higher intraluminal thrombus volume and thickness had correlated positively with the AAA growth in one study but in another study had correlated negatively. AAA compliance demonstrated no correlation with AAA growth and rupture. The aneurysmal wall characteristics showed no association with AAA rupture. However, the metabolism, measured via ultra-small superparamagnetic iron oxide uptake, but none of the other measures, showed a trend toward a relationship with AAA rupture, although the difference was not statistically significant.
CONCLUSIONS
The current measures of aortic wall characteristics have the potential to predict for AAA growth, especially the measures of metabolism and calcification. Evidence regarding AAA rupture is scarce, and, although more work is needed, aortic wall metabolism could potentially be related to AAA rupture. This highlights the role of aortic wall characteristics in the progression of AAA but also has the potential to improve the prediction of AAA growth and rupture.
Topics: Humans; Risk Factors; Aortic Rupture; Aortography; Aortic Aneurysm, Abdominal; Thrombosis; Aorta, Abdominal
PubMed: 35843510
DOI: 10.1016/j.jvs.2022.07.008 -
European Journal of Vascular and... 2022This study aimed to derive a novel classification of blood flow pattern in abdominal aortic aneurysms (AAA) based on computational fluid dynamics (CFDs), and to...
OBJECTIVES
This study aimed to derive a novel classification of blood flow pattern in abdominal aortic aneurysms (AAA) based on computational fluid dynamics (CFDs), and to determine the predictive value of flow patterns in AAA rupture.
METHODS
This was an age and sex matched case control study. Cases were identified as patients who underwent emergency endovascular or open repair due to ruptured or AAA at risk of impending rupture. Controls were age and sex matched with patients with an AAA who were asymptomatic and had a confirmed unruptured AAA from computed tomography angiography images from the same period. Classification of blood flow pattern (type I: non-helical main flow channel with multiple vortices; type II: non-helical main flow channel with single vortices; and type III, helical main flow channel with helical vortices) and haemodynamic parameters (areas of low wall shear stress [A], aneurysm pressure drop [Δ pressure], etc) were derived from CFD analyses. Multivariable regression was used to determine independent AAA rupture risk factors. The incremental discriminant and reclassification abilities for AAA rupture were compared among different models.
RESULTS
Fifty-three ruptured and 53 intact AAA patients were included. Ruptured AAA showed a higher prevalence of type III flow pattern than intact AAA (60.4% vs. 15.1%; p < .001). Type III flow pattern was associated with a significantly increased risk of aneurysm rupture (odds ratio 10.22, 95% confidence interval 3.43 - 30.49). Among all predicting models, the combination of AAA diameter, haemodynamic parameters (A or Δ pressure), and flow pattern showed highest discriminant abilities in both the overall population (c-index = 0.862) and subgroup patients with AAAs < 55 mm (c-index = 0.972). Compared with AAA diameter, adding the flow pattern could significantly improve the reclassification abilities in both the overall population (net reclassification index [NRI] = 0.321; p < .001) and the subgroup of AAAs < 55 mm (NRI = 0.732; p < .001).
CONCLUSION
Type III flow pattern was associated with a significantly increased risk of AAA rupture. The integration of blood flow pattern may improve the identification of high risk aneurysms in both overall population and in those with AAAs < 55 mm.
Topics: Humans; Aortic Aneurysm, Abdominal; Aortic Rupture; Case-Control Studies; Hydrodynamics; Hemodynamics; Risk Factors
PubMed: 35605907
DOI: 10.1016/j.ejvs.2022.05.027 -
European Journal of Vascular and... Dec 2023This study aimed to test whether the relative growth rate of subthreshold abdominal aortic aneurysms (AAAs) in the first 24 months of surveillance predicts the risk of... (Observational Study)
Observational Study
OBJECTIVE
This study aimed to test whether the relative growth rate of subthreshold abdominal aortic aneurysms (AAAs) in the first 24 months of surveillance predicts the risk of future rupture or repair.
METHODS
This was a single centre retrospective observational analysis of all small (< 45 mm diameter) and medium (45 - 54 mm in men, 45 - 50 mm in women) AAAs entered into ultrasound surveillance between January 2002 and December 2019, which received ≥ 24 months of surveillance. Relative growth rates were calculated from measurements taken in the first 24 months of surveillance. The Kaplan-Meier method was used to estimate intervention and rupture free proportions five years following diagnosis for AAAs growing by < 5% and by ≥ 5% in the first 24 months of surveillance. Multivariable Cox regression analysis was used to further analyse this relationship by adjusting for factors found to be significantly associated with outcome in univariable analysis.
RESULTS
A total of 556 patients with AAAs (409 men, 147 women) were followed for ≥ 24 months. This included 431 small AAAs. Of these, 109 (25.3%) grew by < 5% in the first 24 months of surveillance and had a cumulative event free proportion of 0.98 ± 0.05 at five years compared with 0.78 ± 0.05 for the ≥ 5% growth group (p < .001). Of 125 medium AAAs, 26 (20.8%) grew by < 5% in the first 24 months of surveillance and had a cumulative event free proportion of 0.73 ± 0.11 at five years compared with 0.29 ± 0.13 for the ≥ 5% growth group (p = .024). Baseline diameter and early relative growth rate were strongly and independently predictive of future intervention or rupture with hazard ratios of 9.16 (95% CI 5.98 - 14.03, p < .001) and 4.46 (95% CI 2.45 - 8.14, p < .001), respectively.
CONCLUSION
The results suggest that slow expansion of small (< 45 mm) AAAs observed over an isolated 24 month period is indicative of a very low risk of rupture or repair in the medium term. Isolated growth rates may be a useful tool with which to triage low risk AAAs and prevent unnecessary surveillance.
Topics: Male; Humans; Female; Retrospective Studies; Aortic Aneurysm, Abdominal; Ultrasonography; Proportional Hazards Models; Time Factors; Aortic Rupture; Risk Factors
PubMed: 37567340
DOI: 10.1016/j.ejvs.2023.08.006