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Radiologia Mar 2023Abdominal aortic aneurysm is defined as a dilatation of the abdominal aorta greater than 3cm. Its prevalence is between 1 and 1.5 cases per 100 people, constituting an...
Abdominal aortic aneurysm is defined as a dilatation of the abdominal aorta greater than 3cm. Its prevalence is between 1 and 1.5 cases per 100 people, constituting an important cause of morbidity and mortality. Rare in women, its frequency increases with age and its most frequent location is between the renal arteries and the aorto-iliac bifurcation. Approximately 5% of cases will involve the visceral branches. It is a silent pathological process whose natural evolution is rupture, which often has a fatal outcome and whose diagnosis is part of the pathology that we will find in emergency radiology. The involvement of the radiologist and the preparation of an accurate diagnostic report, as soon as possible, is essential for decision-making by the team in charge of the patient's surgery.
Topics: Humans; Female; Aortic Rupture; Aortic Aneurysm, Abdominal; Prevalence; Radiologists; Surgeons
PubMed: 37024231
DOI: 10.1016/j.rxeng.2022.11.003 -
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 -
European Journal of Vascular and... Oct 2021
Topics: Aged; Aortic Aneurysm, Thoracic; Aortic Rupture; Arterial Occlusive Diseases; Constriction, Pathologic; Fatal Outcome; Hemodynamics; Humans; Iliac Artery; Male
PubMed: 34452835
DOI: 10.1016/j.ejvs.2021.06.004 -
Journal of Vascular Surgery Jan 2011
Topics: Aortic Aneurysm, Abdominal; Aortic Rupture; Blood Vessel Prosthesis Implantation; Endovascular Procedures; Humans; Reoperation; Treatment Outcome
PubMed: 21184930
DOI: 10.1016/j.jvs.2010.08.052 -
Turk Kardiyoloji Dernegi Arsivi : Turk... Jul 2023Secondary infection of the aorta is a sporadic and life-threatening disease. It is usually caused by infection and abscess in an adjacent structure. The most common...
Secondary infection of the aorta is a sporadic and life-threatening disease. It is usually caused by infection and abscess in an adjacent structure. The most common mechanism for secondary aortic infection is a psoas abscess eroding the aortic wall, which rarely results in non-aneurysmal aortic rupture. Primary treatment is surgical aortic reconstruction, but the risk of emergency surgical treatment is high. Endovascular aortic stent-graft implantation can be lifesaving in this setting by stopping the bleeding. However, the crucial question of durability and late infections remains unanswered and warrants long-term antibiotic treatment and follow-up. In this report, we present a case of primary psoas abscess, which resulted in non-aneurysmal aortic rupture and its endovascular treatment.
Topics: Humans; Aortic Rupture; Psoas Abscess; Treatment Outcome; Stents; Blood Vessel Prosthesis Implantation; Endovascular Procedures
PubMed: 37450451
DOI: 10.5543/tkda.2023.63458 -
Journal of Medical Primatology Dec 2018Eosinophilic aortitis is a rare condition in animals and humans, and it has been occasionally reported associated with parasitic migration and with a poorly understood...
Eosinophilic aortitis is a rare condition in animals and humans, and it has been occasionally reported associated with parasitic migration and with a poorly understood complex group of autoimmune vasculitides. Here, we describe a case of eosinophilic aortitis with thoracic aortic aneurysm and rupture in a captive-born owl monkey and discuss the differential diagnoses.
Topics: Animals; Animals, Laboratory; Aortic Aneurysm, Thoracic; Aortic Rupture; Aortitis; Aotidae; Eosinophils; Male; Monkey Diseases
PubMed: 30187922
DOI: 10.1111/jmp.12373 -
Medicina (Kaunas, Lithuania) Jul 2021The standard ATLS protocol calls for chest drain insertion in patients with hemothorax before performing further diagnostic steps. However, if trauma-induced thoracic...
The standard ATLS protocol calls for chest drain insertion in patients with hemothorax before performing further diagnostic steps. However, if trauma-induced thoracic aortic rupture is the underlying cause, such drainage can lead to massive bleeding and death of the patient. This report describes a case of a polytrauma patient (car accident), aged 21, with symmetrical chest and decreased breath sounds dorsally on the left. An urgent CT scan revealed subadventitial Grade III thoracic aortic transection with mediastinal hematoma, a massive left-sided hemothorax with mediastinal shift to the right, and other injuries. Stent-graft implantation with subsequent left hemithorax drainage was urgently performed, during which the patient became increasingly unstable from the circulatory point of view. This traumatic hemorrhagic shock was successfully managed at the ICU. Although hemothorax is a serious condition requiring rapid treatment, the knowledge of its origin is of utmost importance; performing chest drainage without bleeding control can lead to circulatory instability and death of the patient. Hence, where aortic injury can be suspected based on the mechanism of the injury, it is beneficial to perform spiral CT angiography for accurate diagnosis first and, in cases of aortic injury, to control the bleeding prior to drainage.
Topics: Aortic Rupture; Hemothorax; Humans; Tomography, X-Ray Computed
PubMed: 34440997
DOI: 10.3390/medicina57080790 -
Diagnostic and Interventional Radiology... 2014We aimed to present our preliminary single-center experience of the endovascular management of thoracic and abdominal aortic ruptures.
PURPOSE
We aimed to present our preliminary single-center experience of the endovascular management of thoracic and abdominal aortic ruptures.
MATERIALS AND METHODS
Between September 2010 and May 2012, 11 consecutive patients (nine males, two females; age range, 26-80 years) with thoracic and abdominal aortic ruptures underwent endovascular repair in our unit. Thoracoabdominal computed tomography (CT) angiography was performed for diagnosis and follow-up. Patients were selected for endovascular repair by a cardiovascular surgeon, anesthesiologist, and interventional radiologist. All repairs were performed using commercially available stent-grafts. The patients were followed up with CT angiography before discharge, at six months, and yearly thereafter.
RESULTS
Three patients died by day 30. One patient died due to an unsuccessful procedure and hemodynamic instability; two patients died because of comorbidities. The other eight patients were followed for six to 24 months after the procedure. No endoleaks or late ruptures were observed during the follow-up period. The patient with iatrogenic thoracic aortic rupture developed paraplegia after the procedure.
CONCLUSION
Reduced mortality due to aortic rupture has been reported with the expanding use of endovascular repair. Reports of small centers are important because of the rarity of these pathologies, and because transferring patients with aortic rupture to a referral center is not usually possible.
Topics: Adult; Aged; Aged, 80 and over; Aorta, Thoracic; Aortic Aneurysm, Abdominal; Aortic Rupture; Aortography; Blood Vessel Prosthesis; Blood Vessel Prosthesis Implantation; Endovascular Procedures; Female; Humans; Male; Middle Aged; Postoperative Complications; Stents; Tomography, X-Ray Computed; Treatment Outcome
PubMed: 24412816
DOI: 10.5152/dir.2013.13165 -
European Journal of Vascular and... Jan 2002to report a single centre experience with endovascular repair of the ruptured descending thoracic and abdominal aorta.
OBJECTIVES
to report a single centre experience with endovascular repair of the ruptured descending thoracic and abdominal aorta.
DESIGN
prospective non-randomised study in a university hospital.
MATERIAL AND METHODS
between 1995 and 2000, endovascular treatment was utilised for 231 aortic repairs; in 37 cases (16%) endografting was conducted on an emergency basis for 21 ruptured infrarenal aortic aneurysms, 15 ruptured descending thoracic aortic lesions, and 1 ruptured thoracoabdominal aortic aneurysm. The feasibility of endovascular treatment and the prostheses' size were determined, based on preoperative spiral CT and intraoperative angiography, both obtained in each patient.
RESULTS
endografting was successfully completed in 35 patients (95%). Primary conversion to open repair was necessary in 2 patients (5%). Postoperative 30-day mortality rate was 11% (4 deaths). No patient developed postoperative temporary or permanent paraplegia. In 2 patients (5%) primary endoleaks required overstenting and in 6 patients (16%) secondary surgical interventions were required. Mean follow-up was 19 months (1-70 months); three deaths occurred within three months postoperatively (1-year survival rate 81+/-6%). In one case, secondary conversion to open repair was necessary 14 months postoperatively.
CONCLUSION
the feasibility of endoluminal repair of the ruptured aorta has been demonstrated. Endoluminal treatment may reduce morbidity and mortality, and may in time become the procedure of choice in certain centres. However, further follow-up is required to determine the long-term efficacy.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Aorta; Aortic Aneurysm; Aortic Rupture; Aortography; Blood Vessel Prosthesis Implantation; Emergency Treatment; Female; Fluoroscopy; Humans; Male; Middle Aged; Prospective Studies; Radiography, Interventional; Stents; Tomography, X-Ray Computed
PubMed: 11748950
DOI: 10.1053/ejvs.2001.1546 -
Turk Kardiyoloji Dernegi Arsivi : Turk... Mar 2020
Topics: Abortion, Induced; Aortic Rupture; Coronary Angiography; Diagnosis, Differential; Echocardiography, Transesophageal; Electrocardiography; Female; Heart Valve Prosthesis Implantation; Humans; Pregnancy; Pregnancy Complications, Cardiovascular; Prenatal Diagnosis; Young Adult
PubMed: 32147659
DOI: 10.5543/tkda.2019.17597