Editor's Choice – Cohort Study Examining the Association Between Abdominal Aortic Size and Major Adverse Cardiovascular Events in Patients with Aortic and Peripheral Occlusive and Aneurysmal Disease

Golledge, Jonathan; Velu, Ramesh; Quigley, Frank; Jenkins, Jason; Singh, Tejas P.

doi:10.1016/j.ejvs.2021.09.011

Cited by 7 publications

(7 citation statements)

References 29 publications

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“…This proportion represents 0.8 per cent of all men screened. Based on the present results and findings from other studies 14 , 15 , 19 , 20 , a fixed aortic diameter of 30 mm, which is widely used in clinical practice, including screening programmes, entails a considerable risk of false-negative results. This is particularly obvious in women owing to their smaller mean aortic diameter 14 , 19 .…”

Section: Discussionsupporting

confidence: 53%

“…Previous studies 15 , 21 have shown an association between ASI and adverse AAA events and other cardiovascular events. Others 15 reported that aortic diameter correlated to height (AHI) was independently associated with AAA events; this was also confirmed in the present study, with a five-fold risk of SAA later developing into an AAA of at least 55 mm with an AHI of 14.6 mm/m or greater.…”

Section: Discussionmentioning

confidence: 86%

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Morphological factors associated with progression of subaneurysmal aortas

Thorbjørnsen

Svensjö

Mani

et al. 2023

British Journal of Surgery

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Background The aim of this population-based cohort study was to assess the association between aortic morphological baseline factors in 65-year-old men with subaneurysmal aortic diameter (25–29 mm) and risk of later progression to abdominal aortic aneurysm (AAA) generally considered to be at a diameter for repair (at least 55 mm). Methods Men with a screening-detected subaneurysmal aorta between 2006 and 2015 in mid-Sweden were re-examined using ultrasonography after 5 and 10 years. Cut-off values for baseline subaneurysmal aortic diameter, aortic size index, aortic height index, and relative aortic diameter (with respect to proximal aorta) were analysed using receiver operating characteristic (ROC) curves, and their associations with progression to AAA diameter at least 55 mm evaluated by means of Kaplan–Meier curves and a multivariable Cox proportional hazard analysis adjusted for traditional risk factors. Results Some 941 men with a subaneurysmal aorta and median follow-up of 6.6 years were identified. The cumulative incidence of AAA diameter at least 55 mm at 10.5 years was 28.5 per cent for an aortic size index of 13.0 mm/m2 or more (representing 45.2 per cent of the population) versus 1.1 per cent for an aortic size index of less than 13.0 mm/m2 (HR 9.1, 95 per cent c.i. 3.62 to 22.85); 25.8 per cent for an aortic height index of at least 14.6 mm/m (58.0 per cent of the population) versus 2.0 per cent for an aortic height index of less than 14.6 mm/m (HR 5.2, 2.23 to 12.12); and 20.7 per cent for subaneurysmal aortic diameter 26 mm or greater (73.6 per cent of the population) versus 1.0 per cent for a diameter of less than 26 mm (HR 5.9, 1.84 to 18.95). Relative aortic diameter quotient (HR 1.2, 0.54 to 2.63) and difference (HR 1.3, 0.57 to 3.12) showed no association with development of AAA of 55 mm or greater. Conclusion Baseline subaneurysmal aortic diameter, aortic size index, and aortic height index were all independently associated with progression to AAA at least 55 mm, with aortic size index as the strongest predictor, whereas relative aortic diameter was not. These morphological factors may be considered for stratification of follow-up at initial screening.

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Section: Discussionsupporting

confidence: 53%

Section: Discussionmentioning

confidence: 86%

Morphological factors associated with progression of subaneurysmal aortas

Thorbjørnsen

Svensjö

Mani

et al. 2023

British Journal of Surgery

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“…This study was part of a prospective cohort study which commenced in 2002 aimed at identifying predictors of outcomes for patients with vascular disease [ 16 , 17 ]. The current study included patients with an asymptomatic unrepaired AAA with a diameter ≥ 30 mm who were recruited between February 2002 and November 2020 from four sites in Australia, including The Royal Brisbane and Women’s Hospital, Gosford Vascular Clinic, The Townsville University Hospital, and the Mater Hospital Townsville [ 10 , 11 , 12 ].…”

Section: Methodsmentioning

confidence: 99%

“…Diabetes, hypertension, ischemic heart disease, and prior stroke were defined based on prior diagnosis or treatment as documented in medical records. Infra-renal aortic diameter was measured from ultrasound or computed tomography imaging performed at the time of recruitment using reproducible protocols previously reported [ 16 ]. The study was approved by Townsville Hospital and Health Services Ethics committee (HREC/14/QTHS/203) and governance authorities and written informed consent was obtained from participants.…”

Section: Methodsmentioning

confidence: 99%

Association of Oral Anticoagulation Prescription with Clinical Events in Patients with an Asymptomatic Unrepaired Abdominal Aortic Aneurysm

et al. 2022

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Background: Most abdominal aortic aneurysms (AAA) have large volumes of intraluminal thrombus which has been implicated in promoting the risk of major adverse events. The aim of this study was to examine the association of therapeutic anticoagulation with AAA-related events and major adverse cardiovascular events (MACE) in patients with an unrepaired AAA. Methods: Patients with an asymptomatic unrepaired AAA were recruited from four sites in Australia. The primary outcome was the combined incidence of AAA repair or AAA rupture-related mortality (AAA-related events). The main secondary outcome was MACE (the combined incidence of myocardial infarction, stroke, or cardiovascular death). The associations of anticoagulation with these outcomes were assessed using Cox proportional hazard analyses (reporting hazard ratio, HR, and 95% confidence intervals, CI) to adjust for other risk factors. Results: A total of 1161 patients were followed for a mean (standard deviation) of 4.9 (4.0) years. Of them, 536 (46.2%) patients had a least one AAA-related event and 319 (27.5%) at least one MACE. In the sample, 98 (8.4%) patients were receiving long-term therapeutic anticoagulation using warfarin (84), apixaban (7), rivaroxaban (6), or dabigatran (1). Prescription of an anticoagulant was associated with a reduced risk of an AAA-related event (adjusted HR 0.61; 95% CI 0.42, 0.90, p = 0.013), but not MACE (HR 1.16; 95% CI 0.78, 1.72, p = 0.476). Conclusions: These findings suggest that AAA-related events but not MACE may be reduced in patients prescribed an anticoagulant medication. Due to the inherent biases of observational studies, a randomized controlled trial is needed to assess whether anticoagulation reduces the risk of AAA-related events.

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“…Additional data included height, weight and the calculated body mass index, body surface area (BSA after DuBois), aortic size index (ASI=maximum diameter/BSA). [25,26] AAA growth: Available previous CTA-based maximum transverse diameters were assessed by two vascular surgeons and included for analysis if the time difference was ≥6months. The annual growth rate was calculated by the first-last-method as described previously and extrapolated mathematically if the time difference was <12months.…”

Section: Additional Patient and Clinical Datamentioning

confidence: 99%

Abdominal aortic aneurysms’ histomorphology differs on the individual patient level and is not associated with classic risk factors – the HistAAA study

Nackenhorst,

Menges,

Bohmann

et al. 2024

Preprint

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Objective: Abdominal aortic aneurysm (AAA) treatment is upon a diameter threshold by open (OAR) or endovascular aortic repair. Attempts for medical growth abrogation have failed. This study aims to elucidate the heterogeneity of AAA based on histomorphology in correlation to individual patient data and aneurysm metrics. Patients and Methods: Aneurysm samples from the left anterior wall from four university center biobanks underwent histologic analysis including angiogenesis, calcification, fibrosis, type and grade of inflammation in adventitia and media. Clinical information included age, comorbidities, etc. as well as type of aneurysm (intact, symptomatic, ruptured, inflammatory). Aneurysm morphology included diameter and semi-automated geometric analysis using Endosize (Therenva) segmentation. Additionally, aneurysm growth was assessed. Results: 364 patient samples (85.4% male, median age 69 years) demonstrated acute (mix/granulocytes) or chronic (monocytes/plasma cells) type inflammation and score, coherent in adventitia and media (p < 0.001), not associated with the type of aneurysm (52x ruptured; 37x symptomatic; p = 0.51) or diameter (57 [52-69] mm; p = 0.87). The degree of fibrosis and the presence of angiogenesis were significantly higher (both p < 0.001) with increasing inflammation score, which significantly decreased with patient age (est = - 0.015/year, p = 0.017). No significant differences in inflammation, fibrosis or angiogenesis were seen for ruptured (vs. intact), acute (vs. elective), male (vs. female) of diabetic (vs. non) patients, while current smoking was associated with more chronic inflammation (p = 0.007) and a higher degree of fibrosis (p = 0.03). Aneurysm geometric morphology (n=252) or differing annual growth rates (n=142) were not significantly associated with histologic characteristics. Conclusion: Type and degree of inflammation are the most distinguishable histologic characteristics in the AAA wall between individual patients. Despite the association to age and smoking status, no significant correlation to any patient or aneurysm specific feature, especially not diameter or rupture exists.

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Editor's Choice – Cohort Study Examining the Association Between Abdominal Aortic Size and Major Adverse Cardiovascular Events in Patients with Aortic and Peripheral Occlusive and Aneurysmal Disease

Cited by 7 publications

References 29 publications

Morphological factors associated with progression of subaneurysmal aortas

Morphological factors associated with progression of subaneurysmal aortas

Association of Oral Anticoagulation Prescription with Clinical Events in Patients with an Asymptomatic Unrepaired Abdominal Aortic Aneurysm

Abdominal aortic aneurysms’ histomorphology differs on the individual patient level and is not associated with classic risk factors – the HistAAA study

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