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Journal of Vascular Surgery Nov 2016Cardiac arrest in patients with ruptured abdominal aortic aneurysm (rAAA) is not uncommon and associated with significantly increased mortality. Although it has been... (Review)
Review
OBJECTIVE
Cardiac arrest in patients with ruptured abdominal aortic aneurysm (rAAA) is not uncommon and associated with significantly increased mortality. Although it has been suggested as a contraindication to aortic repair, the prognostic implications of preoperative cardiac arrest in the face of rAAA are controversial. The purpose of this structured review is to analyze the reported outcomes of patients with rAAA and preoperative cardiac arrest.
METHODS
English language single- and multi-institutional series reporting outcomes of patients with rAAA and cardiac arrest were identified by systematic literature search and review. An aggregate analysis and structured review of outcomes after subsequent aortic repair was performed using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) methodology. The primary outcome was short-term overall mortality.
RESULTS
Sixteen studies involving 2669 patients with rAAA were analyzed, including 334 (13%) with preoperative cardiac arrest. Cardiac arrest was associated with significantly increased mortality compared with patients with rAAA without arrest (86% vs 44%; P < .0001), although cardiac arrest in isolation was poorly predictive of mortality. Four patients were treated by endovascular aortic repair, and all survived. Shorter resuscitation times and return of signs of life prior to aortic repair are associated with improved survival, and long-term functional outcomes among survivors have been reported.
CONCLUSIONS
Mortality among patients with rAAA and preoperative cardiac arrest is high but not prohibitive. Aortic repair should not be withheld from such patients who are otherwise reasonable candidates for intervention, provided resources for emergent aortic repair are available.
Topics: Aortic Aneurysm, Abdominal; Aortic Rupture; Blood Vessel Prosthesis Implantation; Endovascular Procedures; Heart Arrest; Hemodynamics; Humans; Patient Selection; Risk Factors; Treatment Outcome
PubMed: 27473775
DOI: 10.1016/j.jvs.2016.05.085 -
The Journal of Thoracic and... Feb 2021
Topics: Aortic Dissection; Aortic Aneurysm, Thoracic; Aortic Rupture; Dissection; Humans
PubMed: 31859067
DOI: 10.1016/j.jtcvs.2019.11.031 -
Journal of the American Heart... Apr 2021Background Prior studies have suggested aortic peak wall stress (PWS) and peak wall rupture index (PWRI) can estimate the rupture risk of an abdominal aortic aneurysm... (Meta-Analysis)
Meta-Analysis
Background Prior studies have suggested aortic peak wall stress (PWS) and peak wall rupture index (PWRI) can estimate the rupture risk of an abdominal aortic aneurysm (AAA), but whether these measurements have independent predictive ability over assessing AAA diameter alone is unclear. The aim of this systematic review was to compare PWS and PWRI in participants with ruptured and asymptomatic intact AAAs of similar diameter. Methods and Results Web of Science, Scopus, Medline, and The Cochrane Library were systematically searched to identify studies assessing PWS and PWRI in ruptured and asymptomatic intact AAAs of similar diameter. Random-effects meta-analyses were performed using inverse variance-weighted methods. Leave-one-out sensitivity analyses were conducted to assess the robustness of findings. Risk of bias was assessed using a modification of the Newcastle-Ottawa scale and standard quality assessment criteria for evaluating primary research papers. Seven case-control studies involving 309 participants were included. Meta-analyses suggested that PWRI (standardized mean difference, 0.42; 95% CI, 0.14-0.70; =0.004) but not PWS (standardized mean difference, 0.13; 95% CI, -0.18 to 0.44; =0.418) was greater in ruptured than intact AAAs. Sensitivity analyses suggested that the findings were not dependent on the inclusion of any single study. The included studies were assessed to have a medium to high risk of bias. Conclusions Based on limited evidence, this study suggested that PWRI, but not PWS, is greater in ruptured than asymptomatic intact AAAs of similar maximum aortic diameter.
Topics: Aorta, Abdominal; Aortic Aneurysm, Abdominal; Aortic Rupture; Aortography; Asymptomatic Diseases; Biomechanical Phenomena; Humans
PubMed: 33855866
DOI: 10.1161/JAHA.120.019772 -
The Journal of Cardiovascular Surgery Apr 2005Most patients with a traumatic aortic rupture (TAR) were involved in high velocity motor vehicle accidents. Initial management of these patients should be according to... (Review)
Review
Most patients with a traumatic aortic rupture (TAR) were involved in high velocity motor vehicle accidents. Initial management of these patients should be according to the guidelines of the advanced trauma life support group (ATLS). Patients with a suspected TAR are preferably managed by controlled hypotension. TAR can be diagnosed by spiral CT angiography, additional angiography is not needed. Although results from conventional surgery have improved over the years, results from endovascular grafting are better with reduced mortality and paraplegia rates. Acute open surgery has become the second choice and patients are preferably managed by endovascular treatment. The endovascular graft can be placed with a minimal invasive procedure and delay in treatment because of accompanying injuries is avoided. Patients with a TAR treated by an endovascular graft should be kept under surveillance. For optimal patient care level I trauma centers should have thoracic endovascular grafts available for direct use.
Topics: Accidents, Traffic; Aorta, Thoracic; Aortic Rupture; Humans; Vascular Surgical Procedures
PubMed: 15793488
DOI: No ID Found -
Role of mechanotransduction in vascular biology: focus on thoracic aortic aneurysms and dissections.Circulation Research Apr 2015Thoracic aortic diseases that involve progressive enlargement, acute dissection, or rupture are influenced by the hemodynamic loads and mechanical properties of the... (Review)
Review
Thoracic aortic diseases that involve progressive enlargement, acute dissection, or rupture are influenced by the hemodynamic loads and mechanical properties of the wall. We have only limited understanding, however, of the mechanobiological processes that lead to these potentially lethal conditions. Homeostasis requires that intramural cells sense their local chemomechanical environment and establish, maintain, remodel, or repair the extracellular matrix to provide suitable compliance and yet sufficient strength. Proper sensing, in turn, necessitates both receptors that connect the extracellular matrix to intracellular actomyosin filaments and signaling molecules that transmit the related information to the nucleus. Thoracic aortic aneurysms and dissections are associated with poorly controlled hypertension and mutations in genes for extracellular matrix constituents, membrane receptors, contractile proteins, and associated signaling molecules. This grouping of factors suggests that these thoracic diseases result, in part, from dysfunctional mechanosensing and mechanoregulation of the extracellular matrix by the intramural cells, which leads to a compromised structural integrity of the wall. Thus, improved understanding of the mechanobiology of aortic cells could lead to new therapeutic strategies for thoracic aortic aneurysms and dissections.
Topics: Aortic Dissection; Animals; Aorta, Thoracic; Aortic Aneurysm, Thoracic; Aortic Rupture; Biomechanical Phenomena; Disease Progression; Extracellular Matrix Proteins; Genetic Predisposition to Disease; Hemodynamics; Humans; Mechanotransduction, Cellular; Phenotype; Stress, Mechanical
PubMed: 25858068
DOI: 10.1161/CIRCRESAHA.114.304936 -
Journal of the American Veterinary... Dec 2018
Topics: Animals; Aortic Rupture; Diagnosis, Differential; Euthanasia, Animal; Female; Horse Diseases; Horses; Sinus of Valsalva
PubMed: 30668255
DOI: 10.2460/javma.253.12.1551 -
European Journal of Vascular and... Oct 2016Biomechanical characteristics, such as wall stress, are important in the pathogenesis of abdominal aortic aneurysms (AAA) and can be visualised and quantified using... (Review)
Review
OBJECTIVES
Biomechanical characteristics, such as wall stress, are important in the pathogenesis of abdominal aortic aneurysms (AAA) and can be visualised and quantified using imaging techniques. This systematic review aims to present an overview of all biomechanical imaging markers that have been studied in relation to AAA growth and rupture.
METHODS
This systematic review followed the PRISMA guidelines. A search in Medline, Embase, and the Cochrane Library identified 1503 potentially relevant articles. Studies were included if they assessed biomechanical imaging markers and their potential association with growth or rupture.
RESULTS
Twenty-seven articles comprising 1730 patients met the inclusion criteria. Eighteen studies performed wall stress analysis using finite element analysis (FEA), 13 of which used peak wall stress (PWS) to quantify wall stress. Ten of 13 case control FEA studies reported a significantly higher PWS for symptomatic or ruptured AAAs than for intact AAAs. However, in some studies there was confounding bias because of baseline differences in aneurysm diameter between groups. Clinical heterogeneity in methodology obstructed a meaningful meta-analysis of PWS. Three of five FEA studies reported a significant positive association between several wall stress markers, such as PWS and 99th percentile stress, and growth. One study reported a significant negative association and one other study reported no significant association. Studies assessing wall compliance, the augmentation index and wall stress analysis using Laplace's law, computational fluid dynamics and fluid structure interaction were also included in this systematic review.
CONCLUSIONS
Although PWS is significantly higher in symptomatic or ruptured AAAs in most FEA studies, confounding bias, clinical heterogeneity, and lack of standardisation limit the interpretation and generalisability of the results. Also, there is conflicting evidence on whether increased wall stress is associated with growth.
Topics: Aortic Aneurysm, Abdominal; Aortic Rupture; Biomechanical Phenomena; Disease Progression; Finite Element Analysis; Humans; Risk Assessment
PubMed: 27558090
DOI: 10.1016/j.ejvs.2016.07.003 -
Annals of Thoracic and Cardiovascular... Feb 2021Spontaneous rupture of the thoracic aorta is rare. We present a 76-year-old man who developed spontaneous rupture of the aortic arch associated with massive periaortic...
Spontaneous rupture of the thoracic aorta is rare. We present a 76-year-old man who developed spontaneous rupture of the aortic arch associated with massive periaortic hematoma and hypovolemic shock. Because the site of rupture could not be identified, emergency hybrid endovascular aortic repair to shield a long segment of the aorta was performed according to the extent and density of periaortic hematoma on axial CT scans. His blood pressure improved just after deployment of the endograft. Rapid diagnosis by CT and prompt control of aortic hemorrhage by endografting salvaged this patient. Three-dimensional (3D) volume-rendered CT images are useful for identifying the site of aortic rupture, but may not be available in an emergency.
Topics: Aged; Aorta, Thoracic; Aortic Rupture; Blood Vessel Prosthesis; Blood Vessel Prosthesis Implantation; Emergencies; Endovascular Procedures; Humans; Male; Rupture, Spontaneous; Stents; Treatment Outcome
PubMed: 29899177
DOI: 10.5761/atcs.cr.18-00020 -
Journal of Vascular Surgery Jun 2015Elective abdominal aortic aneurysm (AAA) surgery relies on balancing the risk of the intervention against the risk of the aneurysm causing death. Although much is known... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Elective abdominal aortic aneurysm (AAA) surgery relies on balancing the risk of the intervention against the risk of the aneurysm causing death. Although much is known about intervention at 5.5 cm, little is known about the fate of the patient unfit for elective surgery at this threshold. Medical therapy and endovascular surgery have revolutionized management of aortic aneurysms in the last 20 years and are thought to have affected rupture rates.
METHODS
MEDLINE via PubMed, EMBASE, and the Cochrane Library Database were searched for studies reporting follow-up of untreated large AAA approach from inception to January 2014. Data were pooled using random-effects analysis with standardized mean differences and 95% confidence intervals (CIs) reported. The primary end points were rupture rates and all-cause mortality per year by AAA size.
RESULTS
The search strategy identified 1892 citations, of which 11 studies comprising 1514 patients experiencing 347 ruptured AAA were included. The overall incidence of ruptured AAA in patients with AAA >5.5 cm was 5.3% (95% CI, 3.1%-7.5%) per year. This represented cumulative yearly rupture rates of 3.5% (95% CI, -1.6% to 8.7%) in AAAs 5.5 to 6.0 cm, 4.1% (95% CI, -0.7% to 9.0%) in AAAs 6.1 to 7.0 cm, and 6.3% (95% CI, -1.8% to 14.3%) in AAAs >7.0 cm. There was no heterogeneity between studies (I(2) = 0%). Only 32% of these patients were offered repair on rupturing an AAA, with a perioperative mortality of 58% (95% CI, 32%-83%). The risk of death from causes other than AAA was higher than the risk of death from rupture.
CONCLUSIONS
Rupture rates of untreated AAA were lower than those currently quoted in the literature. Non-AAA-related mortality in this group of patients is high.
Topics: Aortic Aneurysm, Abdominal; Aortic Rupture; Cause of Death; Chi-Square Distribution; Contraindications; Elective Surgical Procedures; Humans; Patient Selection; Prognosis; Risk Assessment; Risk Factors; Time Factors; Vascular Surgical Procedures
PubMed: 25661721
DOI: 10.1016/j.jvs.2014.10.023 -
Medicina (Kaunas, Lithuania) 2008Aortic dissection is an acute lesion of the aortic wall accompanied by separation of the media due to rupture or intramural hematoma. The incidence rate of aortic... (Comparative Study)
Comparative Study Review
Aortic dissection is an acute lesion of the aortic wall accompanied by separation of the media due to rupture or intramural hematoma. The incidence rate of aortic dissection is 5 to 30 cases per million people a year. Acute aortic dissection is a highly lethal cardiovascular emergency with an incidence of 2000 new cases per year in the United States and 3000 in Europe. The mortality rate of aortic dissection is 3.2/100,000 per year. In case of sudden death of nonhospitalized patients, aortic dissection was proved in 1.5% of necropsy cases. Most of patients die within 48 hours after admission or 1.4% per each hour. The main clinical manifestations of aortic dissection are acute myocardial infarction, stroke, pulmonary embolism, acute heart failure, acute pancreatitis, mesenteries thrombosis, which mislead the physician. The main measure, which might reduce the mortality, is early diagnosis of aortic dissection. The standard diagnosis is based on clinical symptoms and verification by instrumental (imaging) methods. An alternative mean for diagnosis of aortic dissection might be the determination of concentration of smooth muscle myosin heavy chain protein in blood serum, the peak of which is found after 3 hours after the onset of pain. Normal value of smooth muscle myosin heavy chain protein concentration is 2.5 microg/L, while in case of aortic dissection it exceeds 22.4 microg/L. This diagnostic method has not been introduced in Lithuania yet.
Topics: Adult; Aortic Dissection; Aortic Aneurysm; Aortic Diseases; Aortic Rupture; Aortic Valve Insufficiency; Aortography; Diagnosis, Differential; Echocardiography; Female; Hematoma; Humans; Hypertension; Intensive Care Units; Magnetic Resonance Imaging; Male; Pregnancy; Pregnancy Complications, Cardiovascular; Risk Factors; Tomography, X-Ray Computed; Ultrasonography, Interventional
PubMed: 18413993
DOI: No ID Found