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European Journal of Vascular and... Apr 2020To present the pooled quantitative evidence of basic profiles, initial treatment strategies, and clinical outcomes in patients with isolated abdominal aortic dissection... (Meta-Analysis)
Meta-Analysis
OBJECTIVE
To present the pooled quantitative evidence of basic profiles, initial treatment strategies, and clinical outcomes in patients with isolated abdominal aortic dissection (IAAD).
METHODS
A comprehensive systematic review and meta-analysis was performed of all available studies reporting IAAD, retrieved from the MEDLINE, Embase, and Cochrane Databases. The logistic normal random effect model was fitted using the generalised linear mixed model with random intercepts to calculate the pooled proportion estimates.
RESULTS
Seventeen studies with 482 patients were included in this meta-analysis. Male smokers with hyperlipidaemia and hypertension were the most prominent basic profile. IAADs were predominantly spontaneous and infrarenal, and roughly half were acute and symptomatic. Approximately 67% [95% confidence interval (CI) 42-86%] of patients were managed initially conservatively. In the overall population, the 30 day all cause mortality was 3% (95% CI 1-5%) and the long term mortality during follow up was 8% (95% CI 5-14%). Re-intervention during follow up occurred in 8% (95% CI 5-15%) of patients. In the subgroup analysis, patients with conservative treatment had a 30 day mortality of 1% (95% CI 0-8%), a long term mortality of 5% (95% CI 1-29%), and a re-intervention rate of 18% (95% CI 10-29%). Patients with open surgery had a 30 day mortality of 9% (95% CI 0-82%), a long term mortality of 12% (95% CI 4-31%), and a re-intervention rate of 9% (95% CI 1-44%). Patients with endovascular repair had a 30 day mortality of 2% (95% CI 0-10%), a long term mortality of 5% (95% CI 2-13%), a re-intervention rate of 6% (95% CI 3-13%), and a persistent endoleak rate of 4% (95% CI 2-10%).
CONCLUSION
Appropriate initial treatment strategies can be used to obtain acceptable clinical outcomes in patients with IAAD. Invasive intervention is necessary if patients match certain indications for intervention. Regular imaging surveillance should be provided for all patients, especially those treated conservatively.
Topics: Aortic Dissection; Aortic Aneurysm, Abdominal; Blood Vessel Prosthesis Implantation; Endoleak; Endovascular Procedures; Humans; Risk Factors
PubMed: 31822385
DOI: 10.1016/j.ejvs.2019.05.013 -
Journal of Vascular Surgery Dec 2019Isolated abdominal aortic dissection (IAAD) has remained poorly understood because of its rarity. We explored the prevalence, clinical characteristics, risk factors,... (Meta-Analysis)
Meta-Analysis
OBJECTIVE
Isolated abdominal aortic dissection (IAAD) has remained poorly understood because of its rarity. We explored the prevalence, clinical characteristics, risk factors, imaging characteristics, and treatment strategy of IAAD to facilitate its diagnosis and treatment.
METHODS
We performed a meta-analysis of 17 studies, with single-arm-based and network meta-analysis as the main data synthesis method. The Medline, Embase, and Cochrane library were searched from their inception to July 2018. A total of 9163 patients with aortic disease were enrolled, with IAAD identified in 491 patients.
RESULTS
The pooled prevalence of IAAD among cases of aortic dissection overall, type B aortic dissection, and type A aortic dissection was 1.7% (95% confidence interval [CI], 0.9%-3.4%), 4.1% (95% CI, 2.5%-6.6%), and 2.0% (95% CI, 0.7%-3.9%), respectively. Abdominal pain was the most common symptom (50.8%), followed by back pain (30.5%), and chest pain (21.7%). Up to 41.0% of the patients with IAAD did not present with any clinical symptoms, and up to 71.0% of these patients had negative findings on physical examination. The top three most prevalent risk factors for IAAD were hypertension, hyperlipidemia, and smoking. Most cases of IAAD were limited to the aorta inferior to the renal arteries (81.7%), and the average aortic diameter was 4 cm. No statistically significant difference was observed between open surgery, endovascular aortic repair, and conservative management for both early and late mortality.
CONCLUSIONS
The results from the present meta-analysis regarding IAAD support the following conclusions and recommendations. First, IAAD is rare and predominantly affects males. Second, symptoms (pain) might or might not be present, and physical findings will rarely be found on abdominal examination. Third, hypertension is the most prevalent risk factor. Fourth, most cases IAAD will be infrarenal. Finally, a complication-specific approach, similar to that for type B aortic dissection, would be appropriate.
Topics: Aortic Dissection; Aortic Aneurysm, Abdominal; Humans; Prevalence; Risk Factors
PubMed: 31204217
DOI: 10.1016/j.jvs.2019.04.467 -
European Journal of Vascular and... Aug 2019Aortic graft infection (AGI) is a disastrous complication with an incidence of 0.2-6% in operated patients. With little or no high quality evidence, the best treatment... (Meta-Analysis)
Meta-Analysis
OBJECTIVE
Aortic graft infection (AGI) is a disastrous complication with an incidence of 0.2-6% in operated patients. With little or no high quality evidence, the best treatment option remains unclear. Therefore, the literature on the management of open abdominal AGI was systematically reviewed to determine optimal treatment.
METHODS
In accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, a systematic review and meta-analysis was conducted for AGI. MEDLINE, Embase, and the Cochrane Database of Systematic Reviews were searched. Methodological quality was assessed using the Methodological Index for Non-randomised Studies (MINORS) score. Primary outcomes were 30 day mortality and one year survival. Secondary outcomes were survival, infection recurrence, limb salvage, and graft patency.
RESULTS
Of 1574 studies identified, 32 papers were included in the study. The overall quality of the studies was moderate, with an average MINORS score of 11.9. Pooled overall 30 day mortality and one year survival were 13.5% (95% CI 10.5-16.4) and 73.6% (95% CI 68.8-78.4), respectively. The lowest 30 day mortality and highest one year survival were found for in situ repair compared with extra-anatomic repair and for prosthetic grafts compared with venous grafts or arterial allografts. The infection recurrence rate was highest for prosthetic grafts.
CONCLUSIONS
There is a lack of well designed, qualitative comparative studies making conclusive recommendations impossible. The current best available data suggests that partial graft removal should be avoided and the lowest 30 day mortality and best one year survival are achieved with in situ repair using prosthetic grafts. Initiatives such as the MAGIC database to collaboratively collect prospective data are an important step forward in obtaining more solid answers on this topic.
Topics: Adult; Aged; Aged, 80 and over; Aorta, Abdominal; Arteries; Blood Vessel Prosthesis; Blood Vessel Prosthesis Implantation; Female; Humans; Limb Salvage; Male; Middle Aged; Prosthesis-Related Infections; Recurrence; Reoperation; Risk Assessment; Risk Factors; Time Factors; Treatment Outcome; Vascular Patency; Veins
PubMed: 31178356
DOI: 10.1016/j.ejvs.2019.03.013 -
European Journal of Vascular and... Apr 2018Screening for abdominal aortic aneurysm (AAA) during transthoracic echocardiography (TTE) may be an effective targeted screening strategy. (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Screening for abdominal aortic aneurysm (AAA) during transthoracic echocardiography (TTE) may be an effective targeted screening strategy.
OBJECTIVE
The aim was to assess the feasibility of AAA screening during TTE and to estimate the prevalence of AAA in patients undergoing TTE.
METHODS
Electronic bibliographic sources were interrogated using a combination of free text and controlled vocabulary searches to identify studies reporting on AAA screening during TTE. The review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement standards. Fixed effect or random effects models were used to calculate pooled prevalence estimates.
RESULTS
Twenty observational cohort studies were identified reporting a total of 43,341 participants (23,291 men and 20,050 women). Hypertension was reported in 41% (95% CI 38-43), hypercholesterolemia in 31% (95% CI 29-32), diabetes mellitus in 20% (95% CI 19-22), and tobacco use in 37% (95% CI 35-38). The aorta was visualised in 86% (95% CI 84-88) of the screened population. The pooled prevalence of AAA in the entire screened population was 0.033 (95% CI 0.024-0.044). The pooled prevalence of AAA in men was 0.046 (95% CI 0.032-0.065) and in women it was 0.014 (95% CI 0.008-0.022). The mean age of participants in whom an AAA was detected ranged across the studies from 66 to 85 years. The mean diameter of the aneurysm identified ranged across the studies from 35 mm to 45 mm. Clinical outcomes in participants with a detected AAA were poorly reported.
CONCLUSIONS
Screening for AAA during TTE may identify a population group with a high risk of AAA in whom targeted screening may be beneficial. Further research is required to investigate the cost-effectiveness and clinical benefits of AAA screening in this setting.
Topics: Aortic Aneurysm, Abdominal; Diabetes Mellitus; Echocardiography; Humans; Hypercholesterolemia; Hypertension; Mass Screening; Risk Factors; Smoking
PubMed: 29433798
DOI: 10.1016/j.ejvs.2018.01.003 -
Journal of Vascular Surgery Feb 2014The purpose of this study was to summarize the current evidence of the association between markers of hemostasis and both the presence and size of abdominal aortic... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
The purpose of this study was to summarize the current evidence of the association between markers of hemostasis and both the presence and size of abdominal aortic aneurysms (AAAs).
METHODS
A systematic review and meta-analysis was performed according to Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines by use of the search terms "aneurysm AND abdominal AND aortic AND coagulation" NOT "thoracic." Outcome data including concentration of hemostatic marker, number of patients, and significance level were recorded.
RESULTS
A total of 22 nonrandomized studies were included in the analysis, with a total of 9862 patients. Fibrinogen mean difference (MD) (0.43 g/L; 95% confidence interval [CI], 0.28-0.58 g/L; P ≤ .00001), D-dimer MD (325.82 ng/mL; 95% CI, 199.74-451.89 ng/mL; P ≤ .00001), and thrombin-antithrombin III complex MD (5.58 g/L; 95% CI, 3.34-7.83 g/L; P ≤ .0001) were significantly elevated in the presence of AAAs. Tissue plasminogen activator, prothrombin fragments F1+F2, and platelet count were not shown to be significantly different between patients with and those without AAAs. Meta-regression of studies reporting plasma D-dimer concentration and aneurysm diameter suggests a strong and significant association (r(2) = 0.94; P ≤ .0001).
CONCLUSIONS
This study suggests that the presence of AAAs is associated with increased fibrin turnover, fibrinolysis, and thrombin generation, as shown by increased levels of fibrinogen, D-dimer, and thrombin-antithrombin III complex. This is clinically relevant because markers of hemostasis are independent risk factors for cardiovascular events, highlighting the necessity of addressing all modifiable cardiovascular risk factors in patients with AAAs. Furthermore, the finding that plasma D-dimer concentration appears to have a linear relationship with aneurysm diameter may be useful as a future biomarker of AAAs.
Topics: Antithrombin III; Aorta, Abdominal; Aortic Aneurysm, Abdominal; Biomarkers; Dilatation, Pathologic; Fibrin Fibrinogen Degradation Products; Fibrinogen; Hemostasis; Humans; Peptide Hydrolases; Prognosis; Risk Factors
PubMed: 24461868
DOI: 10.1016/j.jvs.2013.10.088 -
Vascular Aug 2022To elucidate the epidemiology, anatomical, presentation, classification, pathology, investigative modalities, management and prognosis of primary angiosarcoma of the...
PURPOSE
To elucidate the epidemiology, anatomical, presentation, classification, pathology, investigative modalities, management and prognosis of primary angiosarcoma of the aorta.
MATERIAL AND METHODS
A systematic review of literature from the database inception to January 2021 in PubMed and Embase, CINAHL and Cochrane Library in accordance to PRISMA was conducted. Retrieval and extraction was performed by two independent reviewers. The hierarchy of the evidence was assessed through the National Institute for Health and Care Excellence Checklist. Data were subjected to pooled prevalence analysis, Kaplan-Meier survival and test of probability using log-rank analysis. This review is registered with International Prospective Register of Systematic Reviews: RD42021231314.
RESULTS
82 studies with = 123 cases met the inclusion criterion. Abdominal (45%) aorta was the commonest anatomical site with female predominance in ascending aorta (4:1) and aortic arch (2:1). The longest survival was in the ascending aorta and the shortest in the abdominal aorta [540 (interquartile range [IQR], 7-1560 days vs. 180 (IQR, 1-5730 days)], respectively. The overall median survival was 210 days (IQR, 1-5730 days) or 7 months. Lack of metastasis (47%) was a marker of longer survival ( < 0.03) irrespective of other attributes.
CONCLUSION
The pathophysiology appears to be a trend of increasing fatigue, fever and weight loss associated with segmental dysfunction of the aorta projecting occlusive or destructive phenotypes. Computed tomography angiography features of volume-occupying, bulky, polypoid (intraluminal), protrusive vegetation, hyper vascular without atherosclerotic lesions are extremely suggestive of PA of the aorta at 5th and 6th decades of life.
Topics: Aorta, Abdominal; Aorta, Thoracic; Computed Tomography Angiography; Female; Hemangiosarcoma; Humans; Male; Tomography, X-Ray Computed
PubMed: 34238080
DOI: 10.1177/17085381211026491 -
Journal of the American Heart... Jan 2021Background The prognostic importance of abdominal aortic calcification (AAC) viewed on noninvasive imaging modalities remains uncertain. Methods and Results We searched... (Meta-Analysis)
Meta-Analysis
Background The prognostic importance of abdominal aortic calcification (AAC) viewed on noninvasive imaging modalities remains uncertain. Methods and Results We searched electronic databases (MEDLINE and Embase) until March 2018. Multiple reviewers identified prospective studies reporting AAC and incident cardiovascular events or all-cause mortality. Two independent reviewers assessed eligibility and risk of bias and extracted data. Summary risk ratios (RRs) were estimated using random-effects models comparing the higher AAC groups combined (any or more advanced AAC) to the lowest reported AAC group. We identified 52 studies (46 cohorts, 36 092 participants); only studies of patients with chronic kidney disease (57%) and the general older-elderly (median, 68 years; range, 60-80 years) populations (26%) had sufficient data to meta-analyze. People with any or more advanced AAC had higher risk of cardiovascular events (RR, 1.83; 95% CI, 1.40-2.39), fatal cardiovascular events (RR, 1.85; 95% CI, 1.44-2.39), and all-cause mortality (RR, 1.98; 95% CI, 1.55-2.53). Patients with chronic kidney disease with any or more advanced AAC had a higher risk of cardiovascular events (RR, 3.47; 95% CI, 2.21-5.45), fatal cardiovascular events (RR, 3.68; 95% CI, 2.32-5.84), and all-cause mortality (RR, 2.40; 95% CI, 1.95-2.97). Conclusions Higher-risk populations, such as the elderly and those with chronic kidney disease with AAC have substantially greater risk of future cardiovascular events and poorer prognosis. Providing information on AAC may help clinicians understand and manage patients' cardiovascular risk better.
Topics: Aorta, Abdominal; Aortic Diseases; Cardiovascular Diseases; Humans; Mortality; Prognosis; Risk Assessment; Vascular Calcification
PubMed: 33439672
DOI: 10.1161/JAHA.120.017205 -
Current Medical Research and Opinion Dec 2017To evaluate the association of high sensitivity C-reactive protein (hsCRP) with the presence of abdominal aortic aneurysm (AAA). (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
To evaluate the association of high sensitivity C-reactive protein (hsCRP) with the presence of abdominal aortic aneurysm (AAA).
METHODS
Medline, Cochrane, Embase, and Google Scholar databases were searched until 22 June 2016 using the keywords predictive factors, biomarkers, abdominal aortic aneurysm, prediction, high sensitivity C-reactive protein, and hsCRP. Prospective studies, retrospective studies, and cohort studies were included.
RESULTS
Twelve case-control studies were included in the meta-analysis with a total of 8345 patients (1977 in the AAA group and 6368 in the control group). The pooled results showed that AAA patients had higher hsCRP value than the control group (difference in means = 1.827, 95% CI = 0.010 to 3.645, p = .049). Subgroup analysis found AAA patients with medium or small aortic diameter (<50 mm) had higher hsCRP plasma levels than the control group (difference in means = 1.301, 95% CI = 0.821 to 1.781, p < .001). In patients with large aortic diameter (≥50 mm), no difference was observed in hsCRP levels between the AAA and control groups (difference in means = 1.769, 95% CI = -1.387 to 4.925, p = .272). Multi-regression analysis found the difference in means of hsCRP plasma levels between AAA and control groups decreased as aortic diameter increased (slope = -0.04, p < .001), suggesting that hsCRP levels may be inversely associated with increasing aneurysm size.
CONCLUSIONS
Our findings suggest that hsCRP levels may possibly be used as a diagnostic biomarker for AAA patients with medium or small aortic diameter but not for AAA patients with large aortic diameter. The correlation between serum hsCRP level and AAA aneurysm is not conclusive due to the small number of included articles and between-study heterogeneity.
Topics: Aortic Aneurysm, Abdominal; Biomarkers; C-Reactive Protein; Case-Control Studies; Humans; Multivariate Analysis; Regression Analysis
PubMed: 28699805
DOI: 10.1080/03007995.2017.1354825 -
The American Journal of Cardiology Jul 2024The effectiveness of intravascular ultrasound (IVUS) with angiography compared with angiography guidance alone in treating aortic conditions, such as dissections,... (Meta-Analysis)
Meta-Analysis Comparative Study
The effectiveness of intravascular ultrasound (IVUS) with angiography compared with angiography guidance alone in treating aortic conditions, such as dissections, aneurysms, and blunt traumatic injuries, remains unclear. This systematic review and meta-analysis evaluates the current literature for IVUS use during thoracic endovascular aortic repair (TEVAR) and abdominal endovascular aortic repair (EVAR). A comprehensive search of MEDLINE, EMBASE, and Cochrane CENTRAL databases was conducted in March 2024 adhering to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Studies comparing outcomes of TEVAR/EVAR with and without IVUS were identified. The outcomes of interest included contrast volume, fluoroscopy and procedural time, perioperative endoleak, and reinterventions and all-cause mortality during follow-up. Data with 95% confidence intervals (CIs) were extracted. Pooled analysis was performed using a random-effect model. Subgroup analysis was performed stratified by the condition being treated. Risk of bias was assessed using the Newcastle-Ottawa Scale for observational studies. A total of 4,219 patients (n = 2,655 IVUS and n = 1,564 non-IVUS) from 9 observational studies were included. The IVUS group exhibited a reduction in contrast agent volume (weighted mean difference -34.65 mL, 95% CI -54.73 to -14.57) and fluoroscopy time (weighted mean difference -6.13 minutes, 95% CI -11.10 to -1.15), with no difference in procedural time. The perioperative type I and III endoleak occurrences were similar (risk ratio 2.36, 95% CI 0.55 to 10.11; risk ratio 0.72, 95% CI 0.09 to 5.77, respectively). Reintervention and mortality during follow-up were comparable (hazard ratio 0.80, 95% CI 0.33 to 1.97; hazard ratio 0.75, 95% CI 0.47 to 1.18, respectively). All the included studies had small risks of bias. In conclusion, this meta-analysis provides evidence that IVUS enables the safe deployment of TEVAR/EVAR with reduced contrast agent and radiation exposure.
Topics: Humans; Ultrasonography, Interventional; Endovascular Procedures; Aorta, Thoracic; Aorta, Abdominal; Angiography; Aortic Aneurysm, Abdominal; Aortic Aneurysm, Thoracic; Endovascular Aneurysm Repair
PubMed: 38768845
DOI: 10.1016/j.amjcard.2024.05.017 -
European Journal of Vascular and... Jun 2017The aim of this study was to report on the natural history of a population based cohort of 70 year old women with screening detected dilated aortas, and to... (Review)
Review
OBJECTIVE
The aim of this study was to report on the natural history of a population based cohort of 70 year old women with screening detected dilated aortas, and to systematically review publications reporting the rate of intact infrarenal aneurysm repair in women.
MATERIAL AND METHODS
In a previous study, 5140 (74%) of 6925 invited women attended an ultrasound (US) examination of the abdominal aorta at age 70 years. All 52 women with screening detected sub-aneurysms (SA, diameter 25-29 mm) and abdominal aortic aneurysms (AAA, diameter ≥30 mm), were followed for 5 years with US. Infrarenal aortic diameters, AAA repair, all-cause and AAA specific mortality, and risk factors were recorded. In addition, a systematic review was conducted of the rate of intact infrarenal aneurysm repair in women.
RESULTS
A total of 33 (0.6%) women had a SA at the age of 70; two (6%) declined follow-up, five (15%) had died, and 26 were re-examined after 5 years follow-up at age 75. Twelve of 26 (46%) had progressed to AAAs, where one was directly qualified for surgery. Smoking (p = .010) and aortic diameter (p = .040) were associated with progression to AAA. A total of 19 (0.4%) women had an AAA at age 70; two (11%) had died, six (32%) had been electively repaired with no 30 day mortality, and 11 (58%) had an AAA still under surveillance after 5 years follow-up at age 75 years. In the systematic search four studies with heterogeneous cohorts were identified and data on natural history were extracted and reviewed.
CONCLUSION
Screening detected AAAs and sub-aneurysms are clinically relevant in women. Within 5 years of detection a high proportion of AAAs require elective surgery, and a high proportion of sub-aneurysms progress to AAAs. Consequently, surveillance of sub-aneurysms in women with reasonable life expectancy can be considered. Publications on repair rate in women with intact AAAs are scarce and heterogeneous.
Topics: Age Factors; Aged; Aortic Aneurysm, Abdominal; Disease Progression; Elective Surgical Procedures; Female; Humans; Mass Screening; Predictive Value of Tests; Risk Factors; Sex Factors; Smoking; Time Factors
PubMed: 28389251
DOI: 10.1016/j.ejvs.2017.02.024