Abdominal aortic aneurysm expansion rate: Effect of size and beta-adrenergic blockade

Gadowski, Gregory R.; Pilcher, David B.; Ricci, Michael A.

doi:10.1016/s0741-5214(94)70048-6

Cited by 168 publications

(83 citation statements)

References 12 publications

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“…As with thoracic aortic aneurysms, ␤-blocker therapy is considered important for reducing the risk of abdominal aortic aneurysm expansion 52 and rupture. Risk factor modification is fundamental: Hypercholesterolemia and hypertension should be controlled and cigarette smoking discontinued.…”

Section: Medical Managementmentioning

confidence: 99%

Thoracic and Abdominal Aortic Aneurysms

2005

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Section: Medical Managementmentioning

confidence: 99%

Thoracic and Abdominal Aortic Aneurysms

2005

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“…Although no preventive treatment has yet been proved to be effective in vEDS, ␤-blockers are often used by analogy to their efficacy in preventing aortic dissection in patients with Marfan syndrome 19 or abdominal aortic aneurysms. 20 Although the present study has a cross-sectional design and included a small number of patients, it suggests that patients with high carotid wall stress, either steady or pulsatile, are at high risk for arterial dissection and rupture and that a primary therapeutic goal should be to reduce the amplitude of steady and pulsatile wall stresses, in addition to the classic effects of ␤-blockers, ie, reducing heart rate and dP/dt (the rate of change in the central BP with respect to time). According to our findings, ␤-blockers with vasodilating properties should be preferred because they reduce wave reflections and thus pulse pressure to a larger extent than ␤-blockers devoid of vasodilating effect.…”

Section: Clinical Implications Of Findingsmentioning

confidence: 99%

Increased Carotid Wall Stress in Vascular Ehlers-Danlos Syndrome

et al. 2004

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Background-Vascular Ehlers-Danlos syndrome (vEDS), also known as EDS type IV, an inherited disorder of connective tissue, results from mutations in the gene encoding type III procollagen (COL3A1). Affected patients are at risk for arterial dissection or rupture, the main cause of death. To understand the pathogenesis of the vascular lesions, we used a biomechanical approach and determined steady and pulsatile wall stress. Methods and Results-Sixteen patients with vEDS and 16 age-, gender-, and blood pressure-matched control subjects were included in this cross-sectional noninvasive study. Circumferential wall stress was determined under steady and pulsatile conditions at the site of an elastic (common carotid) and a muscular (radial) artery from the measurements of intima-media thickness and internal diameter with high-resolution echo-tracking systems and either mean blood pressure or pulse pressure, respectively. At the site of the carotid artery, steady circumferential wall stress was 43% higher in vEDS patients than in control subjects (68.9Ϯ14.3 versus 48.2Ϯ12.1 kPa, PϽ0.001), and pulsatile circumferential wall stress was 22% higher (28.2Ϯ7.7 versus 23.1Ϯ5.7 kPa, PϽ0.001). Carotid intima-media thickness was 32% lower (408Ϯ56 versus 598Ϯ171 m, PϽ0.001) in vEDS patients, and internal diameter was not different between groups. Radial artery parameters were not significantly different between groups. Conclusions-In vEDS patients, an abnormally low intima-media thickness generates a higher wall stress than in control subjects at the site of an elastic artery, which may increase the risk of arterial dissection and rupture.

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“…Patients with less severe disease and those who are unfit for surgery are also followed long-term. Based on each patient's needs and the extent of disease, a course of intervention is chosen as either medical treatment with β blockers 17,18 and angiotensin converting enzyme inhibitors 19 or surgical treatment, when required. An eurysms and intramural hematomas distal to the aortic arch were evaluated with an intention to treat by endovascular means as a first choice.…”

Section: Imagingmentioning

confidence: 99%

Adding an endovascular aortic surgery program to a rural regional medical centre

Marelli¹,

Woo²,

Watson³

et al. 2013

Can J Surg

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E105 RESEARCH • RECHERCHEAdding an endovascular aortic surgery program to a rural regional medical centre Background: Abdominal aortic aneurysms requiring surgical intervention are generally treated by endovascular means. Such procedures are not always offered in rural hospitals, possibly leaving patients underserved. We reviewed our experience initiating an endoaortic surgery program. Methods:A surgeon in a rural centre was credentialed to perform endovascular aortic aneurysm repair through collaboration with a university centre and was proctored locally for the first 5 abdominal aneurysm repairs. Web-based image storage was used to review complex cases as part of an ongoing partnership. Referred patients were screened for multiple aneurysms and underwent long-term monitoring. Results:In all, 160 patients were evaluated for 176 aortic pathologies. Twenty-five patients (17 men) aged 55-89 years underwent 26 endovascular abdominal (n = 23) or thoracic (n = 3) aortic procedures. Emergent endovascular procedures were not performed. There were no operative deaths, requirements for dialysis or conversions to open repair. Two endoleaks required early reintervention. The median length of stay in hospital for endovascular procedures was 2.5 days. Chronic endoleaks were observed in 7 patients. An additional 8 patients underwent open abdominal aneurysm repair locally and 15 patients were referred to the university program. Conclusion:Creation of an endovascular aortic surgery program in a rural hospital is feasible through collaboration with a high-volume centre. Patient safety is enhanced by obtaining second opinions using web-based image review. Most interventions are for abdominal aortic aneurysms, but planning for a comprehensive aortic clinic is preferable.Contexte : Les anévrismes de l'aorte abdominale justiciables d'une intervention chirurgicale sont généralement traités par voie endovasculaire. Ce type d'intervention n'est toutefois pas toujours pratiqué dans les hôpitaux ruraux. Les patients peuvent donc s'en trouver moins bien desservis. Nous avons passé en revu notre expérience après la mise sur pied d'un programme de chirurgie endoaortique.Méthodes : Grâce à une collaboration avec un centre universitaire, un chirurgien d'un centre rural a reçu l'agrément nécessaire pour effectuer la réparation endovasculaire des anévrismes de l'aorte et il a été supervisé localement pour les 5 premières réparations d'anévrisme de l'aorte abdominale. Une banque d'images sur le Web a permis de passer en revue des cas complexes dans le cadre d'un partenariat continu. On a fait subir aux patients adressés en consultation un dépistage d'anévrismes multiples et ils ont fait l'objet d'un suivi à long terme.

show abstract

Abdominal aortic aneurysm expansion rate: Effect of size and beta-adrenergic blockade

Cited by 168 publications

References 12 publications

Thoracic and Abdominal Aortic Aneurysms

Thoracic and Abdominal Aortic Aneurysms

Increased Carotid Wall Stress in Vascular Ehlers-Danlos Syndrome

Adding an endovascular aortic surgery program to a rural regional medical centre

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