Abdominal aortic aneurysm screening: concepts and controversies

Prabhakar, Anand M.

doi:10.21037/cdt.2017.09.13

Cited by 18 publications

(13 citation statements)

References 39 publications

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“…Finally, 747 valid measurements were adopted (97.6%). After a 5-year follow-up, 71 SAA patients were withdrawn (8.5%), of whom 48 were lost to contact, 12 were died of disease (5 from cerebral hemorrhage, 1 from pancreatic cancer, 1 from lung cancer, 1 from prostate cancer, 1 from respiratory failure, 1 from gastric cancer, 1 from colon cancer, and 1 from accidental death), 11 greater than 2.7 cm (OR = 2.828), smoking after 30 years old (OR = 2.783), moderate hypertension (OR = 2.63), severe hypertension (OR = 2.917), and blood pressure variability (OR = 3.164) had significant statistical significance (Figure 2).…”

Section: Resultsmentioning

confidence: 99%

Analysis of High-Risk Factors Associated with the Progression of Subaneurysmal Aorta to Abdominal Aortic Aneurysm in Rural Area in China

Zhao¹,

Wang²,

et al. 2021

CIA

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Objective: To determine the risk factors associated with the progress of subaneurysmal aorta (SAA) to abdominal aortic aneurysm (AAA) and provide a reference for the prevention of AAA in rural areas. Methods: A total of 747 SAA patients screened by the Health Management Center of the Second Hospital of Lanzhou University from January 2015 to January 2016 were recruited. The ratio of SAA progressing to AAA was observed through 5 years of follow-up. Logistic stepwise regression analysis was performed to analyze the high-risk factors. The relevant clinical prediction model score table (Nom) was made and the C-index and calibration chart were used to verify the prediction ability of the model. Results: Of the 747 patients diagnosed with SAA, 260 developed to AAA, with an incidence of 34.8%. Univariate analysis showed that age (62-65 years old), abdominal aorta diameter greater than 2.7 cm, smoking after 30 years old, moderate to severe hypertension, and blood pressure variability were the important high-risk factors of SAA progressing to AAA. Logistic regression analysis showed that these factors were statistically significant. The nomogram of clinical prediction model score showed that when 50-60% of SAA developed to AAA, the score was 189-201 and the C-index was 0.883, verifying the moderate predictive ability of this model. Conclusion: Age, smoking habit, degree of hypertension, and control situation were highrisk factors associated with the progression of SAA to AAA. The control of the above highrisk factors was imperative for the prevention of AAA in rural areas without sufficient medical resources.

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Section: Resultsmentioning

confidence: 99%

Analysis of High-Risk Factors Associated with the Progression of Subaneurysmal Aorta to Abdominal Aortic Aneurysm in Rural Area in China

Zhao¹,

Wang²,

et al. 2021

CIA

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“…In addition, almost one-third (30.1%) of patients have undergone a diagnostic imaging test within 5 years of screening evaluation that can serve to confirm or refute the presence of aortic ectasia or AAA. National guidelines and a patient’s imaging history therefore represent opportunities for radiology departments to avoid unnecessary imaging and save health-care costs, 12 making AAA screening more cost effective than what has already been shown. 13 We found that, by adhering to CSVS guidelines and reviewing prior imaging tests performed within 5 years, our province could avoid over half (51.2%) of all screening US examinations and save an estimated CAD$52 362.45 per year.…”

Section: Discussionmentioning

confidence: 99%

Appropriateness of Abdominal Aortic Aneurysm Screening With Ultrasound: Potential Cost Savings With Guideline Adherence and Review of Prior Imaging

Murray

Costa

2020

Can Assoc Radiol J

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Objective: To assess the appropriateness of abdominal aortic aneurysm (AAA) screening with ultrasound (US) and potential cost savings by adhering to guidelines and reviewing prior imaging. Methods: Screening aortic US performed in Nova Scotia from January 1 to April 30, 2019, were reviewed. Patient sex, age, risk factors, and study result (negative, <2.5 cm; ectatic, 2.5-2.9 cm; positive for AAA, ≥3 cm) were recorded. Previous imaging tests were reviewed for the presence/absence of aortic ectasia or aneurysm. Appropriateness was based on the Canadian Task Force on Preventive Health Care (CTFPHC) and the Canadian Society of Vascular Surgery (CSVS) guidelines. The number of potentially averted US, subsequent missed positive findings, and cost savings (over the 4-month period) were calculated according to: 1) each guideline; and 2) each guideline combined with review of imaging done 0 to 5 years and 0 to 10 years previously. Results: There were 17 (4.6%) of 369 ectatic aortas and 18 (4.9%) of 369 AAAs. The number of potentially averted examinations, missed ectatic aortas, missed AAAs, and cost savings were as follows, respectively: CTFPHC, 222 (60.2%) of 369, 8, 7, and CAD$20 501.70; CSVS, 117 (31.7%) of 369, 4, 2, and CAD$10 804.95. The model that would yield the greatest cost savings and fewest missed positive findings was the combination of CSVS guidelines with review of prior imaging within 5 years; this would avert 189 (51.2%) of 369 examinations, save CAD$17 454.15 over 4 months, and miss only 2 AAAs and 2 ectatic aortas. Conclusion: Over half of aortic US screening tests can be safely averted by adhering to CSVS guidelines and reviewing imaging performed within 5 years.

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“…The development of an aneurysm in the abdominal aorta seems to be the interaction of environmental and genetic factors [1, 2]. The pathophysiology of this disease process consists in the degradation of the extracellular matrix of the blood vessel wall in response to the accumulation of inflammatory cells such as macrophages and lymphocytes, and the activation of matrix metalloproteinases; and the resulting inflammation, tissue destruction and necrosis produce more cycles of inflammation [2].…”

Section: Discussionmentioning

confidence: 99%

“…Abdominal Aortic Aneurysms (AAA) are defined as focal dilations located in the abdominal aorta from a diameter of at least 50% greater than the normal and healthy segment of this blood vessel (Fig. 1) [1, 2]. The most common location of this disease process is the infrarenal aorta where a diameter that is equal or greater than 30 mm measured by Computed Tomography Angiography (CTA) establishes the diagnosis of AAA [1, 2], Aortic aneurysms of atherosclerotic or degenerative etiology are relatively frequent among men over 65-year-old with a reported prevalence ranging from 3 to 7% determined by imaging studies [1–3]; and its most feared complication is the aneurysm rupture with an associated mortality above 80%.…”

Section: Introductionmentioning

confidence: 99%

“…1) [1, 2]. The most common location of this disease process is the infrarenal aorta where a diameter that is equal or greater than 30 mm measured by Computed Tomography Angiography (CTA) establishes the diagnosis of AAA [1, 2], Aortic aneurysms of atherosclerotic or degenerative etiology are relatively frequent among men over 65-year-old with a reported prevalence ranging from 3 to 7% determined by imaging studies [1–3]; and its most feared complication is the aneurysm rupture with an associated mortality above 80%. In the United States of America (USA), this entity constitutes the 13th leading overall cause of death and according to some authors, this figure is likely to be an underestimation due to approximately 5% of people who die from sudden death may have a rupture AAA as the cause [4].…”

Section: Introductionmentioning

confidence: 99%

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Genetic polymorphism of HLA-DRB1 alleles in Mexican mestizo patients with abdominal aortic aneurysms

et al. 2019

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Background Multiple factors are implicated in the etiology and pathogenesis of Abdominal Aortic Aneurysms (AAA). Available literature of genetic studies has previously suggested the possible roles of autoimmunity, genetic predisposition and ethnic susceptibility. Due to the association with autoimmune diseases and proven application in population genetics, we aimed to investigate alleles of the Class II Human Leukocyte Antigens (HLA-DRB1) in the Mexican Mestizo population with aortic aneurysms and determine possible associations with susceptibility. Methods We performed a case Control Study; the HLA molecular typing was completed for DRB1 loci by LabType Sequence-Specific Oligonucleotide (SSO) SSO-OneLambda kit (Applied Biosystems; Thermo Fisher Scientific. Inc.) in the studied individuals. Allele frequencies (af) were determined, associations were assessed by chi square or fisher exact tests at significance level (< 0.05), and Odds Ratios (OR) were calculated using the STATA software version 14. Results The genetic polymorphism of HLA-DRB1 of fifty one patients (70% males with a mean age of 71 years) with atherosclerotic or also known as degenerative AAA were compared with 99 unrelated patients (60% males, mean age 65 years) without the disease [Control group (CG)] from the same ethnic group. We examined a total of 102 Class II HLA-DRB1 alleles of AAA patients and 198 from CG. When comparing af, we observed the HLA-DRB1*01 af of 0.139 in the AAA compared to 0.05 in the CG [ p = 0.015, OR 3, 95% confidence interval (CI) 1.29–7.08], the HLA-DRB1*16 af were 0.109 in the AAA and 0.025 in CG ( p = 0.006, OR 4.7, 95% CI 1.59–13.98). Conclusions Our study confirmed increased frequencies of the alleles HLA-DRB1*01 and HLA-DRB1*16 and their association to the development of AAA in Mexican Mestizo patients. The utility of genetic testing may assist in identifying individuals at genetic risk for the development of this disease in different ethnic groups, who might benefit from earlier ultrasound screening and closer imaging surveillance.

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Abdominal aortic aneurysm screening: concepts and controversies

Cited by 18 publications

References 39 publications

Analysis of High-Risk Factors Associated with the Progression of Subaneurysmal Aorta to Abdominal Aortic Aneurysm in Rural Area in China

Analysis of High-Risk Factors Associated with the Progression of Subaneurysmal Aorta to Abdominal Aortic Aneurysm in Rural Area in China

Appropriateness of Abdominal Aortic Aneurysm Screening With Ultrasound: Potential Cost Savings With Guideline Adherence and Review of Prior Imaging

Genetic polymorphism of HLA-DRB1 alleles in Mexican mestizo patients with abdominal aortic aneurysms

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