Factors Associated With Small Abdominal Aortic Aneurysm Expansion Rate

Bhak, Rachel H.; Wininger, Michael; Johnson, Gary R.; Lederle, Frank A.; Messina, Louis M.; Ballard, David J.; Wilson, Samuel E.

doi:10.1001/jamasurg.2014.2025

Cited by 103 publications

(97 citation statements)

References 25 publications

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“…Of them, we identifi ed seven eligible studies [9][10][11][12][13][14][15] reporting the association of BMI and AAA growth rates, which included data on a total of 3,768 AAA patients. The patient and AAA characteristics, the details of diameter measurement, and the association between BMI and AAA growth rates are summarized in Table 1 In a prospective study by Burillo et al [13], 122 male patients with a >30 mm AAA were scanned annually with a mean observation time of 8.1 years.…”

Section: Resultsmentioning

confidence: 99%

“…A meta-analysis by Li et al [17] of three epidemiological studies also showed that claudication was a risk factor for AAA (OR, 3.00; 95% CI, 1.74 to 5.19). However, although the association of PAD with AAA growth is still debated, PAD may be not [12] or even negatively [9,19] associated with AAA growth despite its positive association with AAA presence [16,17]. Bhak et al [12] found no independent association between claudication and AAA expansion rates (adjusted MD, -0.1 mm/year; 95% CI, -0.6 to 0.3 mm/year; P = 0.52).…”

Section: Discussionmentioning

confidence: 98%

“…However, although the association of PAD with AAA growth is still debated, PAD may be not [12] or even negatively [9,19] associated with AAA growth despite its positive association with AAA presence [16,17]. Bhak et al [12] found no independent association between claudication and AAA expansion rates (adjusted MD, -0.1 mm/year; 95% CI, -0.6 to 0.3 mm/year; P = 0.52). Unexpectedly, Brady et al [9] demonstrated that lower ankle/brachial pressure index (indicating more severe PAD) was independently (after adjustment for potential confounding variables including diabetes) associated with slower AAA growth (adjusted MD per -0.2 units, -0.22 mm/year; 95% CI, -0.34 to -0.10 mm/year).…”

Section: Discussionmentioning

confidence: 98%

“…Additionally, unhealthy obese adults have approximately a 9-fold higher risk, and healthy obese patients have an approximately 4-fold higher risk of developing type 2 diabetes than healthy normal-weight people [36]. In three [9,12,15] of the seven reviewed studies, however, BMI was not associated with AAA growth, even after adjustment for diabetes as one of the potential confounding variables in their multivariate analyses. Additionally, ultrasonography, computed tomography (CT), or both were used to measure AAA diameters in each reviewed study, as summarized in ESM 1.…”

Section: Limitationsmentioning

confidence: 96%

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The association between body mass index and abdominal aortic aneurysm growth: a systematic review

Takagi

Umemoto

2016

Vasa

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Summary: Diabetes, a state of relative insulin resistance, is negatively associated with both the presence and growth abdominal aortic aneurysms (AAA), which could suggest a protective role of obesity against AAA presence or growth. A recent meta-analysis demonstrated a trend toward a positive, though statistically non-signifi cant, association between body mass index (BMI) and the presence of AAA. With respect to the association between obesity and AAA growth, however, the evidence had been very limited. To determine whether obesity (or BMI) is associated with AAA growth, we reviewed currently available studies with a systematic literature search. Our comprehensive search identifi ed seven eligible studies reporting the association of BMI and AAA growth rates, which included data on a total of 3,768 AAA patients. All seven identifi ed studies demonstrated no association between BMI and AAA growth. Despite a trend toward a positive association between BMI and AAA presence, the reason why BMI is not associated with AAA growth (suggested in the present review) is unclear. A discrepancy between associated comorbidities (coronary artery disease, peripheral artery disease, and chronic obstructive pulmonary disease) and AAA presence and between the same comorbidities and AAA growth, however, could be identifi ed. Further investigations are required to elucidate why BMI is not associated with AAA growth despite the trend for a positive association with AAA presence.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 98%

Section: Discussionmentioning

confidence: 98%

Section: Limitationsmentioning

confidence: 96%

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The association between body mass index and abdominal aortic aneurysm growth: a systematic review

Takagi

Umemoto

2016

Vasa

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“…Another recent (published in 2013) meta-analysis by Li et al 2 of three epidemiological studies also showed that CAD was a risk factor for AAA (OR, 1.82; 95% CI, 1.65 to 2.00). Despite the evidence for the positive association of CAD with AAA presence, however, CAD may be not 3 or even negatively 4 associated with AAA growth. Using a large clinical database from the ADAM (Aneurysm Detection and Management) study, Bhak et al 3 found no association between angina or CAD and AAA expansion rates.…”

Section: Introductionmentioning

confidence: 84%

Coronary artery disease and abdominal aortic aneurysm growth

Takagi

Umemoto

2016

Vasc Med

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To determine whether coronary artery disease (CAD) is associated with abdominal aortic aneurysm (AAA) growth, we performed a meta-analysis of currently available studies. Databases including MEDLINE and EMBASE were searched through October 2015 using PubMed and OVID. Search terms included enlargement, expansion, growth, or progression; rate or rates; and abdominal aortic aneurysm. Studies considered for inclusion met the following criteria: the design was unrestricted; the study population was AAA patients with and without CAD; and outcomes included data regarding AAA growth. For each study, growth rates in both the CAD and non-CAD groups were used to generate standardized mean differences (SMDs) and 95% confidence intervals (CIs). Of 664 potentially relevant publications screened initially, we identified 20 eligible studies including data on a total of 7238 AAA patients. A pooled analysis of all 20 studies demonstrated a statistically significant association of CAD with slower AAA growth rates (i.e. a significantly negative association of CAD with AAA growth) in the fixed-effect model (SMD, -0.06 [-0.0592]; 95% CI, -0.12 [-0.1157] to -0.00 [-0.0027]; p = 0.04). There was minimal between-study heterogeneity (p = 0.16) and a statistically non-significant association of CAD with slower AAA growth rates (i.e. a non-significantly negative association of CAD with AAA growth) in the pooled result from random-effects modeling (SMD, -0.06; 95% CI, -0.13 to 0.01; p = 0.12). In conclusion, CAD may be negatively associated with AAA growth.

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Evaluating Growth Patterns of Abdominal Aortic Aneurysm Diameter With Serial Computed Tomography Surveillance

et al. 2021

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IMPORTANCE Small abdominal aortic aneurysms (AAAs) are common in the elderly population. Their growth rates and patterns, which drive clinical surveillance, are widely disputed.OBJECTIVE To assess the growth patterns and rates of AAAs as documented on serial computed tomography (CT) scans. DESIGN, SETTING, AND PARTICIPANTSCohort study and secondary analysis of the Non-Invasive Treatment of Abdominal Aortic Aneurysm Clinical Trial (N-TA 3 CT), a randomized, double-blind placebo-controlled clinical trial conducted from 2013 to 2018, with CT imaging every 6 months for 2 years. The trial was a multicenter, observational secondary analysis, not related to treatment hypotheses of data collected in the N-TA 3 CT. Participants included 254 patients with baseline AAA diameter between 3.5 and 5.0 cm. EXPOSURES Patients received serial CT scan measurements, analyzed for maximum transverse diameter, at 6-month intervals. MAIN OUTCOMES AND MEASURESThe primary study outcome was AAA annual growth rate. Secondary analyses included characterizing AAA growth patterns, assessing likelihood of AAA diameter to exceed sex-specific intervention thresholds over 2 years.RESULTS A total of 254 patients, 35 women with baseline AAA diameter 3.5 to 4.5 cm and 219 men with baseline diameter 3.5 to 5.0 cm, were included. Yearly growth rates of AAA diameters were a median of 0.17 cm/y (interquartile range [IQR], 0.16) and a mean (SD), 0.19 (0.14) cm/y. Ten percent of AAAs displayed minimal to no growth (<0.05 cm/y), 62% displayed low growth (0.05-0.25 cm/y), and 28% displayed high growth (>0.25 cm/y). Baseline AAA diameter accounted for 5.4% of variance of growth rate (P < .001; R 2 , 0.054). Most AAAs displayed linear growth (70%); large variations in interval growth rates occurred infrequently (3% staccato growth and 4% exponential growth); and some patients' growth patterns were not clearly classifiable (23% indeterminate). No patients with a maximum transverse diameter less than 4.25 cm exceeded sex-specific repair thresholds at 2 years (men, 0 of 92; 95% CI, 0.00-0.055; women, 0 of 25 ; 95% CI, 0.00-0.247). Twenty-six percent of patients with a maximum transverse diameter of at least 4.25 cm exceeded sex-specific repair thresholds at 2 years (n = 12 of 83 men with diameter ranging from 4.25 to <4.75 cm; 95% CI, 0.091-0.264; n = 21 of 44 men with diameter ranging from 4.75-5.0 cm; 95% CI, 0.362-0.669; n = 3 of 10 women with diameter Ն4.25 cm; 95% CI, 0.093-0.726).CONCLUSIONS AND RELEVANCE Most small AAAs showed linear growth; large intrapatient variations in interval growth rates were infrequently observed over 2 years. Linear growth modeling of AAAs in individual patients suggests smaller AAAs (<4.25 cm) can be followed up with a CT scan in at least 2 years with little chance of exceeding interventional thresholds.

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Factors Associated With Small Abdominal Aortic Aneurysm Expansion Rate

Cited by 103 publications

References 25 publications

The association between body mass index and abdominal aortic aneurysm growth: a systematic review

The association between body mass index and abdominal aortic aneurysm growth: a systematic review

Coronary artery disease and abdominal aortic aneurysm growth

Evaluating Growth Patterns of Abdominal Aortic Aneurysm Diameter With Serial Computed Tomography Surveillance

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